[00:01:15] I. OH. MY. [00:05:47] OH. OH. OH. OH. MY. READY. GOOD AFTERNOON, LADIES AND GENTLEMEN. TODAY IS WEDNESDAY, AUGUST 7TH, 2024. COMMISSIONERS COURT IS MEETING IN SPECIAL OPEN SESSION. WOULD YOU PLEASE RISE AND JOIN US FOR THE PLEDGE OF ALLEGIANCE? FLAG OF THE UNITED STATES OF [1. OPEN MEETING] AMERICA. AND TO THE REPUBLIC FOR WHICH IT STANDS. ONE NATION UNDER GOD, INDIVISIBLE, WITH LIBERTY AND JUSTICE FOR ALL. GOOD AFTERNOON, AND WELCOME TO THE JOINT MEETING OF THE EL PASO COUNTY HOSPITAL DISTRICT BOARD OF MANAGERS AND THE EL PASO COUNTY COMMISSIONERS. COMMISSIONERS, THANK YOU FOR WELCOMING US INTO YOUR HOME. THE TIME IS 109, AND AT THIS POINT, WE WOULD LIKE TO CALL THE MEETING TO ORDER AND ESTABLISH A QUORUM. YES, MR. CHAIR, WE DO HAVE A QUORUM. WONDERFUL. AND AT THIS POINT, CAN WE GO INTO THE REGULAR AGENDA? AND WOULD YOU MIND READING THOSE TWO ITEMS INTO RECORD? AGENDA ITEM NUMBER ONE. DISCUSS AND TAKE APPROPRIATE ACTION REGARDING THE FISCAL YEAR 2025. [2. PLEDGE OF ALLEGIANCE] EL PASO COUNTY HOSPITAL DISTRICT OPERATING AND CAPITAL BUDGET AGENDA ITEM NUMBER TWO DISCUSS AND TAKE APPROPRIATE ACTION REGARDING THE PROPOSED TAX RATE FOR THE EL PASO COUNTY HOSPITAL DISTRICT. MR. RJ GIBSON, PRESIDENT AND CEO. MR. MICHAEL NUNEZ, DISTRICT CHIEF FINANCIAL OFFICER. COMMISSIONERS JACOBSON THRONE, PRESIDENT AND CEO OF THE EL PASO COUNTY HOSPITAL DISTRICT. AS WE GO THROUGH THIS PRESENTATION, YOU'RE GOING TO HEAR ABOUT SOME OF THE PERFORMANCE WE'VE HAD AND THE GROWTH WE'VE EXPERIENCED AS A HOSPITAL DISTRICT, WHAT WE'RE DOING IN TERMS OF OUR OPERATIONS AND AS WELL AS OUR BUDGET EXPECTATIONS, NOT ONLY HOW WE PERFORMED IN THE PAST, BUT WHAT WE ARE PROPOSING FOR THE FISCAL YEAR 25 BUDGET. AND YOU'LL SEE SOME AREAS WHERE WE'RE EXPERIENCING SOME GROWTH THAT ARE VERY POSITIVE FOR US IN THE EL PASO HEALTH SIDE, BEING ABLE TO PICK UP THE STAR PLUS PROGRAM, WHICH WILL ADD SOME REVENUE FOR US AND WILL FOR THE FIRST TIME, [00:10:03] ALLOW US TO THEN START LOOKING AT PATIENTS THAT ARE 65 AND OLDER. TYPICALLY THEY'VE BEEN LOOKING AT YOUNG, YOU KNOW, YOUNG ADULTS AND CHILDREN. YOU'LL ALSO BE ABLE TO SEE SOME GROWTH ANTICIPATED AT EL PASO CHILDREN'S. ONCE WE OPEN THAT EIGHTH FLOOR SHELL THAT SHOULD BE COMPLETED SO THAT THEY CAN BEGIN OPERATING IN OCTOBER AND PROVIDES AN ADDITIONAL 26 BEDS. AND THEN WE HAVE SOME GROWTH OPPORTUNITIES THAT ARE GOING TO BE REFLECTED IN THE BUDGET AS WELL. MICHAEL WILL START WITH GOING OVER THE BRIEF SCHEDULE OF EVENTS IN TERMS OF THE BUDGET, AND THEN WE'RE GOING TO HAVE JOHN LAU GO OVER SOME OF THE DATA POINTS THAT WE HAVE FOR OUR BUDGET TO BE FOLLOWED THEN BY MARIA ZAMPINI, OUR CHIEF OPERATING OFFICER, AND SHE'LL GO OVER SOME OF THE GROWTH WE'VE EXPERIENCED AS A DISTRICT OVER THE LAST FEW YEARS. SO, MICHAEL, MAY I INTERRUPT FOR A MOMENT WHILE I READ IN OUR ITEMS, PLEASE? THANK YOU. THIS AFTERNOON WE'RE JOINED BY ASL INTERPRETERS STEPHANIE MICHELLE AND NAYELI CABRAL. I ALSO NEEDED TO ANNOUNCE THAT OUR YOUTUBE FEED IS DOWN, BUT WE ARE STREAMING ON OUR INTERNAL STREAM, SO THAT IS CONCURRENT. WE HAVE OUR ITEM NUMBER THREE. PUBLIC COMMENT. DO WE HAVE ANYBODY IN THE AUDIENCE THAT WOULD LIKE TO PROVIDE PUBLIC COMMENT AT THIS TIME? HEARING NONE WILL TAKE NO ACTION. ITEM NUMBER FOUR FROM THE REGULAR AGENDA FOR A RECEIVE A PRESENTATION REGARDING THE FISCAL YEAR 2025. [3. PUBLIC COMMENT] EL PASO COUNTY HOSPITAL DISTRICT OPERATING AND CAPITAL BUDGET AND ITEM NUMBER FOUR B DISCUSS AND TAKE APPROPRIATE ACTION ON THE EL PASO COUNTY HOSPITAL DISTRICT'S CAPITAL AND OPERATING BUDGETS FOR FISCAL YEAR 2025 AND PROPOSED TAX RATE. THANK YOU. THANK YOU. GOOD AFTERNOON, COMMISSIONERS. [A. Receive a presentation regarding the Fiscal Year 2025 El Paso County Hospital District Operating and Capital Budget. R. Jacob Cintron, President & CEO, University Medical Center/EPCHD, 915-521-7600] MY NAME IS MICHAEL NUNEZ. I'M THE HOSPITAL DISTRICT CHIEF FINANCIAL OFFICER. I WILL LEAD IT OFF WITH THE WITH THE BUDGET TIMETABLE. [B. Discuss and take appropriate action on the El Paso County Hospital District’s Capital and Operating Budgets for FY 2025 and proposed tax rate. R. Jacob Cintron, President & CEO, University Medical Center/EPCHD, 915-521-7600] THERE'S ONE SLIGHT CHANGE THAT HAPPENED THIS PAST WEEK. WE INITIALLY WERE PLANNING THE TAX ASSESSOR WAS, WAS WAS GOING TO BE HERE THIS PREVIOUS MONDAY TO TO PRESENT THE THE ORGANIZATIONS UMC NO NEW REVENUE AND VOTER APPROVAL TAX RATE. THAT'S GOING TO HAPPEN NOW ON MONDAY AUGUST 12TH. SO CURRENTLY RIGHT NOW WE'RE WE ARE AUGUST 7TH LOOKING TO DO OUR FIRST BUDGET WORK SESSION. THE SECOND BUDGET WORK SESSION IF NEEDED IS CURRENTLY SCHEDULED FOR THURSDAY, AUGUST 22ND. AND THEN CURRENTLY RIGHT NOW, WHAT IS SLATED AND WORKING WITH THE WITH THE COUNTY STAFF. THERE'S A THERE'S A TENTATIVE DATE FOR A PUBLIC HEARING ON TAX RATE IF NEEDED. CURRENTLY RIGHT NOW THAT'S MONDAY, AUGUST 19TH. AND THEN OUR GOAL OR PER THE CALENDAR IS TO BRING BACK THE ON MONDAY, AUGUST 26TH, THE TO THE COURT. SO I WAS IT TO APPROVE THE UMC'S OPERATING BUDGET, CAPITAL BUDGET, DEBT SERVICE BUDGET AND ALSO TAX RATE. SO WITH THAT, I'M GOING TO TURN THIS OVER NOW TO JOHN, WHO'S GOING TO TAKE US IN TERMS OF, YOU KNOW, SOME OF THE HISTORY THAT WE'VE HAD WITH WITH THE EL PASO COUNTY HOSPITAL DISTRICT. COMMISSIONERS. GOOD AFTERNOON. JOHN LAW. I'M THE DISTRICT CHIEF STRATEGY OFFICER FOR THE EL PASO COUNTY HOSPITAL DISTRICT. I JUST WANT TO WALK THROUGH A LITTLE BIT OF OUR GROWTH AND TALK A LITTLE BIT ABOUT WHAT THAT MEANS. AS YOU CAN SEE HERE, YOU CAN SEE THE DISTRICT'S GROWTH AND REVENUE AND EXPENSES GOING BACK TO 2017. AND THE BUDGET YOU'RE GOING TO SEE PROPOSED TODAY IS GOING TO HAVE A 1.7 BILLION IN BOTH REVENUE AND EXPENSES. SO YOU CAN SEE THERE'S BEEN TREMENDOUS GROWTH OVER THE LAST SEVEN EIGHT YEARS. WHAT I WANT TO TALK A LITTLE BIT IS ABOUT IS, IS WHAT IS THAT GROWTH MEANT AND WHERE, YOU KNOW, WE'VE FOR THE MOST PART WE'VE SPENT THE REVENUE WE'VE MADE. AND SO WHAT DOES THAT MEAN IN TERMS OF THE ORGANIZATION? ONE OF THE AREAS WHERE WE'VE WE'VE INVESTED SOME OF OUR REVENUE IS IN OUR ASSOCIATES. AND HERE YOU'LL SEE HOW WE'VE INCREASED THE MINIMUM WAGE UP TO $15 AN HOUR. WHAT YOU SEE IN THE RIGHT COLUMN IS THE FIRST YEAR COST FOR THAT INCREASE FROM EACH INCREMENTAL LEVEL. AND OBVIOUSLY THAT COST CONTINUES INTO THE FUTURE. SO YOU'RE ESSENTIALLY ONLY SEEING THE FIRST YEAR COST, BUT YOU CAN SEE WHAT'S BEEN INVESTED OVER TIME. IN OUR ASSOCIATES THROUGH THIS MINIMUM WAGE INCREASE. AND WHAT YOU'RE NOT SEEING HERE AS WELL. AND IS, IS ACTUALLY THE COMPRESSION. SO, YOU KNOW, WHEN WE RAISE THE SALARIES OF CERTAIN ASSOCIATES. THERE'S ASSOCIATES THAT ALSO GET THEIR SALARIES RAISED TO MAKE SURE THERE'S PARITY ACROSS THE POSITIONS. SO YOU CAN SEE THAT IT'S IT'S A SIGNIFICANT INVESTMENT IN OUR ASSOCIATES TO INCREASE THE MINIMUM WAGE. AND JOHN, IF I MIGHT BE ABLE TO INTERRUPT JUST FOR A SECOND. I, I THANK YOU ALL. IF YOU LOOK AT 2016 TO 2024 AND WHAT AN IMPACT IT HAS ON THOSE EMPLOYEES, THAT RIPPLES ALL THE WAY ACROSS TO TO YOUR MDS. [00:15:03] IT REALLY IS VERY TELLING OF AN ORGANIZATION HOW THEY FEEL ABOUT ALL THEIR EMPLOYEES, NOT JUST THE THE DOCTORS AND NURSES, BUT HOW THEY FEEL ABOUT EVERYBODY. AND WE UNDERSTAND ABOUT THE COMPRESSION. BETSY AND I HAVE BEEN TALKING ABOUT THAT SAME ISSUE. AND HOW IT AFFECTS US HERE AT THE COUNTY. WE HAVE MANY OF OUR 381 PEOPLE BUSINESSES COMING TO EL PASO. THAT'S ONE OF THE FIRST THINGS WE LOOK AT IS WHAT ARE THEY PAYING THEIR EMPLOYEES? AND IF WE CAN'T WALK THE SAME WALK, HOW CAN WE PREACH SOMETHING ELSE? SO I CONGRATULATE YOU ON ALL YOUR BUDGET, BUT ESPECIALLY THAT ONE ITEM, COMMISSIONER LEON, THE PUSH TO GO FROM A $10 MINIMUM WAGE TO 15. REALLY? YOU ALL DESERVE A LOT OF CREDIT FOR THAT, BECAUSE I REMEMBER MANY DISCUSSIONS WHERE YOU WERE CONCERNED ABOUT THE LIVING WAGE AND HOW, GIVEN ALL THAT'S BEEN GOING ON WITH INFLATION, HOW THAT WAS VERY DIFFICULT. SO WHEN YOU LOOK AT THE OVERALL IMPACT OF JUST GOING FROM $10 TO 15, IT'S ABOUT 29 MILLION. AND AS AN ANNUAL IMPACT, NOT COUNTING COMPRESSION, I'D SEEN AN EARLIER NUMBER WE'RE TRYING TO VALIDATE. THAT SAID, WITH COMPRESSION IT WAS ABOUT 55 MILLION MORE DOLLARS A YEAR WITH THIS IMPACT. AND WE ALSO RECOGNIZE THAT TODAY THE $15 MAY NOT BE ENOUGH, AND THAT WE MAY NEED TO LOOK AT THE IN THE NEAR FUTURE. GETTING TO A MORE APPROPRIATE LEVEL TO BE ABLE TO PROVIDE A LIVING WAGE. AND WE'RE STILL COMMITTED TO DO THAT IN THIS FISCAL YEAR. YOU'LL FIND, THOUGH, THAT WE DIDN'T INCLUDE IT JUST SIMPLY BECAUSE, YOU KNOW, SOME OF THE CHALLENGES WE'RE FACING AND THE FACT THAT, YOU KNOW, NO SECRET, WE'RE GOING TO BE GOING FOR A NO NEW REVENUE RATE. THANK YOU. AND AND PART OF THAT INVESTMENT AND OBVIOUSLY WE'VE WE'VE DEVELOPED A WHOLE RANGE OF PROGRAMS. AND, AND MY ONGOING THEME IS IS WHERE DID THIS YOU KNOW, THIS GROWTH IN REVENUE GO. AND SO WE'VE DONE A LOT OF INVESTMENTS IN OUR ASSOCIATES. LORENA NAVARRO AND HER TEAM HAVE DEVELOPED PROGRAMS TO HELP GET LOANS FOR FIRST TIME HOME BUYERS. WE'VE GOT A PROGRAM FOR ASSOCIATES WHERE THEY WORK PART TIME AND AND WE PAY THEM FULL TIME SO THEY CAN GET EDUCATION TO GET PROMOTED. WE'VE ALSO INVESTED IN, IN A A PSYCHOLOGIST. WE'RE ADDING A SECOND TO MAKE SURE THE BEHAVIORAL HEALTH SUPPORT IS THERE FOR OUR ASSOCIATES. AND SO WHAT YOU CAN SEE HERE IS JUST THE THE ANNUALIZED TURNOVER AND AND HOW IT'S DECLINED COMING OUT OF THE PANDEMIC. SO FOR OUR ASSOCIATES OVERALL WE'VE COME DOWN TO ABOUT 11%. AND THEN FOR OUR BEDSIDE NURSES WE'VE COME DOWN TO 12%. AND I WAS AT A CONFERENCE LAST WEEK. AND AND REALLY THE LEVEL OF TURNOVER WE'RE AT IS UNPRECEDENTED. WHEN I TALK TO OTHER OTHER ORGANIZATIONS AROUND THE COUNTRY. HERE, YOU'LL SEE THAT EL PASO CHILDREN'S HAS HAD SIMILAR SUCCESS COMING OUT OF THE PANDEMIC. AND YOU CAN SEE HOW THEY'VE ALSO DECREASED THEIR ANNUALIZED TURNOVER OVERALL AND ALSO BEDSIDE. AND SO AGAIN, THIS IS ALL PART OF INVESTMENTS THAT THEY'VE MADE AS WELL IN THEIR WORKFORCE. ANOTHER AREA WHERE WE'VE INVESTED AND WE CONTINUE TO INVEST IS THE EDUCATION OF OUR FUTURE HEALTHCARE WORKFORCE. AND WHAT YOU'RE SEEING HERE ARE STUDENTS THAT ARE GETTING SOME TYPE OF CLINICAL EXPERIENCE AT EITHER UMC OR EL PASO CHILDREN'S. AND YOU CAN SEE THAT, YOU KNOW, AT THIS POINT, WE'RE WE'RE PROVIDING SOME CLINICAL EDUCATION TO OVER 3000 PEOPLE THAT ARE LOOKING TO GET INTO HEALTHCARE. AND I, I WOULD VENTURE TO GUESS THAT WE ARE BY FAR THE LARGEST CLINICAL SITE FOR FOR STUDENTS ACROSS THIS COUNTRY, ACROSS EL PASO. AND THIS DOESN'T JUST INCLUDE, LIKE, NURSES. IT INCLUDES PHLEBOTOMISTS. IT INCLUDES ALL THE ANCILLARY ROLES THAT NEED DIFFERENT KINDS OF TRAINING THAT THEY'RE GETTING AT AT UNIVERSITY MEDICAL CENTER IN EL PASO CHILDREN'S. WE ALSO, OVER THIS TIME FRAME, HAVE CONTINUED TO INVEST IN THE FELLOWS AND RESIDENTS WITH TEXAS TECH. AND YOU CAN SEE THE THE GROWTH THERE IN IN BOTH SIDES OF THE COIN. OBVIOUSLY THE FELLOWS AND THE RESIDENTS ARE THE INDIVIDUALS MOST LIKELY TO STAY HERE AND PRACTICE MEDICINE. SO THIS IS A REAL VALUABLE INVESTMENT. AND YOU CAN SEE HOW WHAT WE SPEND HAS INCREASED YEAR OVER YEAR AS WELL. WE WE CONTINUE TO BE PROUD OF OUR OUR RELATIONSHIP WITH TEXAS TECH. ANOTHER PLACE WHERE WE'VE INVESTED OUR OUR INCREASED REVENUE IS IN THAT PARTNERSHIP WITH TEXAS TECH. AND IN 2023, OUR CONTRACTS AND PAYMENTS TO TEXAS TECH REACHED ALMOST 98 MILLION. SO WE WE CONTINUE TO BE STRONG PARTNERS AND KEY INVESTORS IN TEXAS TECH AND ITS SUCCESS. BEYOND THAT, WE'VE HAD SOME OTHER ACCOMPLISHMENTS. AND YOU CAN SEE THEM ON THE SLIDE. YOU KNOW, OBVIOUSLY THE SURGICAL HOSPITAL ACQUISITION IS A REAL POSITIVE IN TERMS OF EXPANDING SOME [00:20:07] CAPACITY FOR US. I WANT TO HIGHLIGHT THE SPECIALISTS THAT BOTH UMC AND EL PASO CHILDREN'S HAVE BEEN ABLE TO RECRUIT. YOU CAN YOU CAN SEE THE LIST OF SPECIALTIES THAT WE'VE BROUGHT ON BOTH OF OUR TEAMS. AND AGAIN, WE'RE REALLY ADDRESSING AREAS WHERE THERE ARE NO PROVIDERS, PARTICULARLY ON THE PEDIATRIC SIDE OR THE WORKFORCE IN THESE SPECIALTIES IS VERY WEAK. AND AND WE'RE TRYING TO BUILD THAT UP. I ALSO WANT TO HIGHLIGHT THE PEDIATRIC MULTI-SPECIALTY CLINIC THAT THAT EL PASO CHILDREN'S HAS OPENED THIS YEAR. YOU KNOW, AGAIN, IT'S THE ONLY MULTI-SPECIALTY CLINIC FOR KIDS. AND ESPECIALLY, AS YOU KNOW, WE SEE THE DATA OVER THE LAST 20 YEARS, WE'RE SEEING MORE KIDS WITH WITH MULTIPLE DISEASES. AND THIS TYPE OF MULTI-SPECIALTY ENVIRONMENT IS REALLY KEY FOR THEIR CARE. HERE ARE SOME ACCOMPLISHMENTS THAT ARE REAL SPECIFIC TO UMC. AND YOU KNOW, I'VE TALKED ALREADY A LITTLE BIT ABOUT THE TURNOVER AND OUR REDUCTION THERE. I WANT TO HIGHLIGHT OUR CLINICAL DOCUMENTATION INITIATIVE. THIS IS AN INITIATIVE WHERE WE'VE BEEN WORKING WITH OUR PROVIDERS TO MAKE SURE THEY'RE DOCUMENTING ACCURATELY. WHAT WE HAVE FOUND HISTORICALLY IS THAT THEY WERE, IN A SENSE UNDER DOCUMENTING THE CARE THAT THEY'VE PROVIDED. AND SO WE'VE DONE A LOT OF TRAINING, AND WE THINK THAT ATTRIBUTES ABOUT 7 MILLION ANNUALLY TO THE BOTTOM LINE. AND THE OTHER THING I WANT TO HIGHLIGHT IS THE DA VINCI ROBOT ACQUISITION. WE'RE THE ONLY HOSPITAL SYSTEM IN THE REGION THAT HAS THIS ROBOT TODAY. WE'RE THE FIRST ONES TO GET IT. AND AND THAT PROVIDES A VALUABLE RESOURCE TO INCREASE THE QUALITY OF CARE FOR OUR SYSTEM. THE LAST PLACE, AGAIN, THINKING ABOUT WHERE WE HAVE INVESTED, THE REVENUE THAT WE'VE GROWN. WE CONTINUE TO BE VERY PROUD OF OUR INVESTMENT IN THE UNINSURED. AND SO IF YOU LOOK AT THE ORANGE BAR, YOU CAN SEE WHAT WE'VE RECEIVED FROM THE PROPERTY TAXES. IN 2025, WE WE ESTIMATE THAT THAT'S GOING TO BE ABOUT $129 MILLION. AND THEN THE BLUE LINE SHOWS THE COST OF THE CARE THAT'S PROVIDED TO INDIVIDUALS WITHOUT INSURANCE. AND I JUST WANT TO UNDERSCORE THAT THAT IS THE COST. A LOT OF HEALTH CARE SYSTEMS, WHEN THEY REPORT WHAT THEY DO FOR THE UNINSURED, THEY REPORT EITHER THEIR CHARGES OR MAYBE WHAT THEY WOULD HAVE COLLECTED, WHICH ARE HIGHER NUMBERS. WE'RE ACTUALLY REPORTING WHAT IS THE BASE COST JUST TO PROVIDE THAT CARE. AND AND OBVIOUSLY WE'RE PROVIDING MORE CARE THAN WE'RE RECEIVING THE DOLLARS FOR. SO WITH THAT, I'M GOING TO HAND IT OVER TO MARIA ZAMPINI AND LET HER TALK ABOUT OPERATIONS. GOOD AFTERNOON. SO HOW ARE WE DOING? I'M LUCKY TO BE ABLE TO PRESENT THESE SLIDES BECAUSE THE, THE, THE GROWTH THAT WE'VE HAD AND THE SUCCESS THAT WE'VE HAD HAS, HAS REALLY BEEN MEASURABLE AND AND IMPACTFUL. ON THE FIRST ONE, YOU CAN SEE THIS FIRST GRAPH. YOU SEE THE ADMISSIONS OVER TIME. AND YOU SEE THERE THAT BETWEEN THE DISTRICT, BETWEEN EL PASO CHILDREN'S HOSPITAL AND UMC. WE'VE SEEN A 23. WE'VE SEEN OVER 23,000 ADMISSIONS FROM THE 2017 NUMBERS. SO THAT REPRESENTS A 28% INCREASE. SO IF YOU GO BACK TO 2017 TO NOW. AND SO IN ORDER TO BE ABLE TO DO THAT, THAT'S CONSISTENT AND MEASURABLE. MEASURABLE SUCCESS YEAR OVER YEAR ON THE OUTPATIENT VISITS. THIS ALSO SHOWS QUITE A BIT OF AN INCREASE. AND SO THE OUTPATIENT VISITS FOR US ARE ALL THE PRIMARY, THE SPECIALTY CARE VISITS. IT ALSO INCLUDES EVERYTHING LIKE LAB AND IMAGING, THE EMERGENCY DEPARTMENTS REHAB, EVERYTHING THAT COMES WITH A PHYSICIAN OFFICE VISIT AS WELL. AND SO THAT GROWTH IS IMPRESSIVE IN 2017 TO NOW IT'S A IT'S A 56% INCREASE TO THE DISTRICT. WE'RE NOW SEEING A LITTLE BIT OVER 1.2 MILLION OUTPATIENT VISITS TO THE DISTRICT, WHICH IS QUITE A BIT AS YOU AS YOU MAY REMEMBER, WE OPENED TWO NEW CLINICS IN 2017. THOSE WERE OUR NEIGHBORHOOD HEALTH CENTERS AND TWO NEW EMERGENCY DEPARTMENTS IN 2020. AND SO THAT HELPED GET US TO WHERE WE ARE NOW. WE'RE PATIENT CENTERED MEDICAL HOMES. SO WHAT WE'RE DOING IS ACTIVELY COORDINATING THE CARE OF EACH AND EVERY PATIENT. AND SO WE BRING THEM IN FOR LABS, FOR PHARMACEUTICALS, FOR EVERYTHING THAT THEY MAY NEED. AND SO WHAT WE WANT IS THOSE CLINICS TO BE ABLE TO SEE ABOUT 80% AND YARDS TO SEE ABOUT 80% OF WHAT YOU WOULD NEED IN A LIFETIME. AND THAT'S REPRESENTED BY THOSE BY THAT NUMBER OF VISITS. WE'VE ALSO ADDED MANY SPECIALISTS. I THINK JOHN TALKED ABOUT IT AS WELL. AND SO IN THOSE CLINICS WE NOW HAVE CARDIOLOGY, WE HAVE ENDOCRINOLOGY, WE HAVE SURGERY, ORTHOPEDICS, [00:25:02] ALL ALL OF THOSE. AND THERE'S MORE, BUT THOSE ARE SOME OF THE SPECIALISTS THAT WE'VE ADDED. THE CHILDREN'S HOSPITAL, AS JOHN SAID, HAS OPENED UP AN URGENT CARE AND A MULTI-SPECIALTY CLINIC THAT ADDS TO THEIR CLINIC SYSTEM IN THE LAST COUPLE OF YEARS. AND SO ALL OF THESE EFFORTS HAVE BEEN VERY SUCCESSFUL. AND AND WHAT WE'RE DOING IS REALLY GROWING ACCESS TO HEALTHCARE IN THE EL PASO COMMUNITY. SO WE'RE PUTTING ALL OF THESE WHERE THE PATIENTS ARE IN THE NEIGHBORHOODS. AND YOU CAN SEE HOW THAT NUMBER HAS REALLY INCREASED OVER TIME. SURGERY CASES ON THE NEXT SLIDE. AND THIS ALSO YOU SEE THAT TREND LINE JUST INCREASING AS WELL. SO WE'VE GROWN TO OVER 18,000 SURGICAL CASES. THAT'S A 76% INCREASE FROM WHERE WE WERE IN 2017. MAJOR CONTRIBUTION AGAIN IS JUST THE ACTIVE RECRUITMENT OF SPECIALISTS IN NEUROSURGERY, ORTHOPEDICS, OMFS AND OTHERS. BUT YOU CAN SEE HOW SUCCESSFUL THAT'S BEEN. ON THE EL PASO HEALTH, THE STAR AND THE CHIP MARKET SHARE. EL PASO HEALTH HAS BEEN THE MARKET SHARE LEADER SINCE 2014, AND YOU CAN SEE FROM THE TREND LINE THAT THEY HAVE 60% OF THE MARKET, ALMOST 60% OF THE MARKET IN STAR AND CHIP. AND SO COMBINED, IF YOU LOOK AT SUPERIOR AND MOLINA, WHICH ARE THE THE TWO LINES BELOW IT. WE HAVE EL PASO HEALTH HAS MORE THAN, THAN WHAT THEY WOULD HAVE COMBINED. AND ON THE EL PASO HEALTH, ON THEIR MEMBERSHIP SIDE, THEY HAVE ABOUT 89,000 MEMBERS. SO THAT THAT'S ABOUT ROUGHLY 10% OF THE POPULATION THAT WE'RE COVERING. AND SO THAT'S A THAT'S A HUGE NUMBER. AND THEN STARTING IN SEPTEMBER THEY'RE GOING TO BE ADDING A LITTLE MORE THAN 9300 STAR PLUS MEMBERS. SO BRINGING THEM TO ABOUT 100,000 MEMBERS, WHICH IS WHICH IS REALLY GOOD. SO POSITIVE WINS THROUGHOUT ALL OF THESE SERVICES. AND WITH THAT I'LL HAND IT OVER TO MICHAEL, WHO WILL TALK TO US ABOUT OUR FINANCIAL HEALTH. THANK YOU. OKAY. MICHAEL NUNEZ HOSPITAL DISTRICT CHIEF FINANCIAL OFFICER ON SLIDE 21. WHAT I DO WANT TO PRESENT IS WHERE WE ARE WITH OUR WITH OUR LATEST BOND RATING AGENCIES. WE'VE HAD A LOT OF ACTIVITY WITH THE RATING AGENCIES, PARTICULARLY BECAUSE WE ARE DOING SOME REFUNDING OF SOME OF OUR BONDS. IN FACT, THE SETTLEMENT DATE IS GOING TO BE ON TUESDAY. SO WE'VE WE WE DID ENLIST A KROLL AT THE AT THE RECOMMENDATION OF HILLTOP SECURITIES AND ALSO OUR BOND SYNDICATE. WE DECIDED TO GO WITH ANOTHER RATING AGENCY KROLL. NOW KROLL DOES RATE THE PUBLIC SAFETY HOSPITALS DIFFERENTLY THAN, SAY, MOODY'S. PARTLY BECAUSE THEY DO PUT MORE EMPHASIS ON THE ON THE GENERAL OBLIGATION TAX BACK TO A DEBT THAT WE HAVE. SO IN FACT, ABOUT LAST WEEK, THEY DID COME OUT WITH A DOUBLE A MINUS A STABLE OUTLOOK. AND THIS WAS ABOUT A WEEK AGO. ABOUT A WEEK AGO. THEN ALSO FITCH RATINGS. THEY HAD EARLIER IN MARCH DONE A RATING UPDATE FOR US, OF WHICH IT WAS A MINUS WITH A STABLE OUTLOOK BECAUSE OF THE BOND REFUNDING WE ARE DOING NEXT WEEK. THEY DID DO ANOTHER REASSESSMENT AND THEY DID MAINTAIN THE CURRENT A MINUS STABLE OUTLOOK AS WELL. AND ABOUT TWO WEEKS AGO WE DID HAVE OUR OUR ANNUAL SURVEILLANCE WITH WITH STANDARD AND POOR'S. ALTHOUGH WE'RE NOT GOING TO BE USING STANDARD AND POOR'S FOR THE FOR THE BOND REFUNDINGS. THEY THEY REAFFIRMED AT THEIR, AT THEIR CURRENT RATE OF WHERE WE'RE WE ARE A TRIPLE B+ STABLE OUTLOOK. AND THAT WAS DONE ABOUT ABOUT TWO WEEKS AGO. AND THEN THE LAST ONE WAS MOODY'S. NOW WE HAVEN'T BEEN EVALUATED THEM SINCE ABOUT WAS IT SEPTEMBER OF 22? AND WE HAVE THE LOWEST RATING WITH THEM AT A BAR TWO. SO THAT'S THE CURRENT PICTURE OF OUR OF THE BOND RATING. BOND RATING AGENCIES I GUESS REPORT CARD ON THE HOSPITAL DISTRICT. ANY QUESTIONS ON THAT? MICHAEL, JUST A QUICK FOR YOUR. I'D LIKE TO KNOW WHAT YOUR OPINION IS. WHY IS THERE SUCH A DIFFERENCE BETWEEN KROLL AND MOODY'S? YEAH. AND KROLL, GOING BACK TO WHAT I HAD MENTIONED, THEY DO PUT MORE EMPHASIS ON THE GENERAL OBLIGATION TAX BACKED DEBT. THE THAT THAT WE DO HAVE, WHEREAS MOODY'S, THEY THEY DON'T PLACE AS MUCH EMPHASIS ON THAT. AND THEY DO EVALUATE US, SUCH AS WE ARE ACROSS THE BOARD, SUCH AS A REGULAR FOR PROFIT HOSPITAL. SO THAT'S THE MAIN DIFFERENCE BETWEEN THE RATING METHODOLOGY, BETWEEN KROLL AND WHAT MOODY'S WOULD BE. SO MOODY'S IS RATING YOU JUST AS THOUGH YOU WERE A FOR PROFIT, SIMILAR TO A FOR PROFIT LIKE HCA AND TENET, IN TERMS OF WHEN WE START LOOKING AT AT OUR MARGINS VERSUS LIKE TENET AND HCA FOR PROFIT MARGINS AND HOW OURS ARE LOWER. SO THAT'S HOW THEY'RE THAT'S HOW THEIR RATING SYSTEM IS, IS COMPARED TO KROLL. AS A POINT OF COMPARISON, IF YOU LOOK AT FITCH THEY RATED UMC THE DISTRICT AS AN A MINUS. [00:30:04] THEY'VE RATED HCA AS A A DOUBLE B+ STABLE, WHICH IS LOWER. AND THEY RATED TENET AS A B+ POSITIVE, WHICH IS ALSO LOWER. SO THESE ARE FOR PROFIT ORGANIZATIONS. THEY CARRY A LOT OF DEBT. AND THEY AND WE HAVE A HIGHER RATING THROUGH FITCH THAN HCA AND TENET, THOUGH CLEARLY AS A FOR PROFIT, THEY THEY GENERATE MORE REVENUE BECAUSE THERE'S NOT THAT PUBLIC MANDATE THAT THEY, THEY PROVIDE UNCOMPENSATED CARE AT ALL LEVELS. THANK YOU. NOW TALKING NOW AS WE GET INTO THE DETAILS OF THE FISCAL YEAR 2025 BUDGET. FIRST OFF, WHAT I DO WANT TO EMPHASIZE IS ON THE ON THE LEFT, A PIE CHART IS GOING TO BE WHAT THE DISTRICT 25 2025 REVENUE BUDGET IS. IT'S GOING TO BE RIGHT SORT OF A 1.7 BILLION TO WEAR WITH THAT WHEN YOU'RE LOOKING AT NET PATIENT SERVICE REVENUE OF 755 MILLION, OR 45% OF THE HOSPITALS DISTRICTS BUDGET, NOW THAT IS NET PATIENT SERVICE REVENUE FOR BOTH UMC AND EL PASO CHILDREN'S. LOOKING AT THE ORANGE PIECE, THIS IS PREMIUM REVENUE. THIS IS EL PASO HEALTH. NOW, YOU'LL LATER ON IN THE PRESENTATION, YOU'LL SEE THAT THEIR PREMIUM REVENUE IS GOING TO INCREASE ABOUT 200 MILLION FROM 2024 TO 2025. AND THAT'S BECAUSE OF THE OF THEM GETTING INTO STAR PLUS STARTING SEPTEMBER 1ST. SO THEIR SO THEIR REVENUE IS 533 MILLION OR 32% OF THE OF THE DISTRICT'S OPERATING BUDGET. OUR MEDICAID SUPPLEMENTAL REVENUE. THIS IS FOR PRIMARILY UMC ALTHOUGH EL PASO CHILDREN'S DOES GET SOME MEDICAID SUPPLEMENTAL REVENUE. THAT'S ABOUT 7%. AND THEN PROPERTY TAX REVENUE, AS JACOB ALLUDED EARLIER. THIS BUDGET DOES, DOES ASSUME GOING WITH A NO NEW REVENUE RATE. WE'RE ESTIMATING THAT TO BE ABOUT 152 MILLION IN TOTAL, ABOUT 24 MILLION OF THAT IS GOING TO BE FOR DEBT SERVICE. AND THEN THE REMAINING IS GOING TO BE FOR MAINTENANCE AND OPERATIONS. SO PROPERTY TAX REVENUE AS A WHOLE REPRESENTS ABOUT 9%. AND THEN WE HAVE OTHER REVENUES ABOUT 111,000,007%. ON THE RIGHT SIDE WILL BE WHAT MAKES UP THE THE DISTRICT 2025 EXPENSE BUDGET. ALSO JUST SORT OF ABOUT 1.7 BILLION. SALARIES AND WAGES 26%. ABOUT 434. AND THIS IS FOR ALL ENTITIES, WHETHER IT'S UNIVERSITY MEDICAL CENTER, EL PASO CHILDREN'S, EL PASO HEALTH, THE TWO FOUNDATIONS OR EMPLOYEE BENEFITS IS ABOUT 90 MILLION OR 5%. PHYSICIAN FEES. THESE ARE THE FEES THAT WE THAT WE PAY TO OUR PROVIDERS, WHETHER IT'S TEXAS TECH, LOCAL COMMUNITY PHYSICIANS FOR FOR COVERAGE, CONTRACTS, MEDICAL DIRECTORSHIPS, ETC. ARE PURCHASED. SERVICES 121 MILLION. SUPPLIES AND PHARMACEUTICALS. THIS IS MEDICAL SUPPLIES PHARMACEUTICALS FOR BOTH UMC AND EL PASO CHILDREN'S. THIS IS ABOUT 237,000,014%. NOW THE GREEN PIECE IS GOING TO BE THE MEDICAL CLAIMS. THIS IS WITH EL PASO HEALTH. NOW YOU'LL SEE ON THE REVENUE SIDE IN THE ORANGE PART, THAT'S ABOUT 533 MILLION IN PREMIUM REVENUE. BUT IN MEDICAL EXPENSES WE EXPECT TO PAY ABOUT 463 MILLION. AND I'LL REFER TO LATER ON WHAT'S CALLED THE MEDICAL LOSS RATIO. WHAT A MEDICAL LOSS RATIO IS FOR EVERY DOLLAR OF PREMIUM REVENUE THAT EL PASO HEALTH GETS FROM THE STATE, ABOUT 89%, 88% OF THAT IS USED TO PAY MEDICAL CLAIMS TO HOSPITALS OR TO OR TO PROVIDERS. AND THEN YOU'LL SEE THE OTHER COMPONENTS OUR OTHER DEPRECIATION AND AMORTIZATION, WHICH IS NON-CASH. I'LL BE TALKING ABOUT THAT LATER AS WELL. THAT'S ABOUT 57 MILLION. AND THEN OUR INTEREST ON OUR DEBT IS ABOUT 17 MILLION. SO THOSE ARE THE MAJOR COMPONENTS. WHEN YOU LOOK AT THE REVENUE BUDGET AND THE EXPENSE BUDGET FOR THE HOSPITAL DISTRICT FOR 2025. WHEN YOU'RE LOOKING OUT AT THE AT WHAT WE ARE PRESENTING FOR FISCAL YEAR 2025 AS A WHOLE, THE COMBINED TOTAL IS LOOKING TO BE A POSITIVE INCREASE IN NET POSITION OR NET ASSETS OF ABOUT $3.3 MILLION. WHEN YOU LOOK AT IT FROM AN INDIVIDUAL COMPONENT UNIT BASIS, YOU'LL SEE UMC IS ABOUT 15, ABOUT $16 MILLION NEGATIVE. AND THERE'S ONE MAIN REASON FOR THAT, WHICH I'LL BE TALKING ABOUT THAT HERE IN ABOUT TWO MORE SLIDES. EL PASO HEALTH WE'RE LOOKING AT ABOUT 5.5 MILLION INCREASE IN NET POSITION FOR 2025. EL PASO CHILDREN'S ABOUT 8.6 MILLION INCREASE IN NET POSITION. THE FOUNDATION NOW HERE IT'S LABELED UMC FOUNDATION. BUT IT'S ACTUALLY BOTH THE UMC FOUNDATION AND EL PASO CHILDREN'S FOUNDATION WITH THEIR WITH THEM. THEM ALSO CONTINUE TO GROW AT ABOUT $3.3 MILLION. SO WHEN YOU LOOK AT CASH FLOW FROM OPERATIONS, YOU SEE THAT THE INCREASE IN NET POSITION IS ABOUT 3.3 MILLION. BUT THAT DOES INCLUDE THE NON-CASH DEPRECIATION AND AMORTIZATION EXPENSE OF ABOUT 57 MILLION. SO WHEN YOU LOOK AT WHAT DO WE GENERATE CASH, CASH FLOW FROM OPERATIONS, THAT'S ABOUT 60 MILLION. [00:35:01] LATER ON I'LL BE TALKING ABOUT WHERE DO WE USE THAT 60 MILLION. ABOUT HALF OF IT'S GOING TO OUR DEBT SERVICE IN TERMS OF INTEREST AND PRINCIPAL PAYMENTS. AND THEN THE OTHER HALF IS GOING TO ROUTINE CAPITAL CAPITAL INVESTMENT FOR BOTH FOR ALL THREE UMC EL PASO AND EL PASO HEALTH. IN TALKING ABOUT SOME OF THE MAJOR COMPONENTS FOR EACH OF THE INDIVIDUAL COMPONENT UNITS, LET'S TALK ABOUT UMC. FIRST OFF, THE THE BIGGEST UNCERTAINTY OR THE BIGGEST CHALLENGE THAT WE HAVE IN OUR 2025 YEAR. AND I THINK WE'VE BEEN TALKING ABOUT THIS FOR THE PAST COUPLE OF YEARS. ARE THE FEDERAL MEDICAID DISPROPORTIONATE SHARE CUTS? CURRENTLY RIGHT NOW, AND THIS GOES BACK TO WHEN THE AFFORDABLE CARE ACT WAS PASSED BACK IN 2010 THAT CONGRESS HAD AUTHORIZED A FEDERAL MEDICAID DISPROPORTIONATE SHARE CUTS TO BEGINNING BEGIN IN 2014. THE THEORY BEING, AS WITH THE AFFORDABLE CARE ACT, IT WAS FULLY IMPLEMENTED ACROSS ALL STATES, THAT THERE WOULD BE MORE INSURED PEOPLE ACROSS THE COUNTRY AND LESS UNINSURED. SO THUS THUS THE DISPROPORTIONATE SHARE PROGRAM WAS GOING TO BE REDUCED. BUT THOSE CUTS HAVE NEVER HAPPENED EVERY YEAR SINCE 2014. AND SOMETIMES THERE'S A TWO YEAR DELAY. SOMETIMES THERE'S A THREE YEAR A THREE YEAR DELAY. BUT THESE CUTS HAVE HAVE HAVE NEVER HAPPENED. NOW CURRENTLY, RIGHT NOW THE CUTS ARE DELAYED UNTIL DECEMBER 31ST OF 2024, WHICH IS THREE MONTHS INTO OUR INTO OUR 2025 FISCAL YEAR. SO WITH THAT, ASSUMING THAT THE FEDERAL CUTS TO MEDICAID DISPROPORTIONATE SHARE ARE NOT DELAYED, THAT'S ABOUT A 40% IMPACT TO THE STATE OF TEXAS, OR ABOUT 400 MILLION TO UMC. THAT'S ABOUT A $20 MILLION REDUCTION. SO WITH THAT, BECAUSE OF THAT UNCERTAINTY WE HAVE NOT BUDGETED FOR. IF WE WERE TO RECEIVE 100% OF OUR MEDICAID DISPROPORTIONATE SHARE FUNDS. NOW, WHAT'S GOING TO HAPPEN IS CURRENTLY RIGHT NOW WE'VE GOT THE NATIONAL ELECTIONS IN EARLY NOVEMBER. NOVEMBER 5TH. NOW, AFTER THAT, AND THIS IS WHAT MOST OF THE MOST OF THE PEOPLE IN THE INDUSTRY ARE SAYING, THE THE CONGRESS THAT IS GOING TO BE IN PLACE BETWEEN NOVEMBER 5TH OF 2024 TO DECEMBER 31ST OF 2024. MORE THAN LIKELY, THEY'RE GOING TO PASS A 60 DAY CONTINUING RESOLUTION WITH A WITH A FUNDING OF OF MEDICAID DISH UNTIL PROBABLY FEBRUARY 28TH OF 2025. AND WHY IS THAT? IS THAT WHEN THE NEW CONGRESS COMES INTO PLACE OR THE NEW IF THERE'S A NEW PRESIDENCY, THE HOUSE LEADERSHIP, SENATE LEADERSHIP, IT'LL THEN BE UP TO THEM AS TO WHAT THEY'RE GOING TO DO WITH THESE, WITH THESE MEDICAID DISH CUTS. SO WE ARE HOPING THAT WHEN IT COMES TO THAT, IS THAT THE THE NEW CONGRESS IN IN 2025 WILL DELAY THESE CUTS FURTHER. BUT BECAUSE WE WE DON'T KNOW WHETHER THAT'S A CERTAINTY EVEN THOUGH IT'S NEVER HAPPENED. WE HAVE NOT BUDGETED FOR THAT. SO THAT'S THE MAIN REASON WHY. CURRENTLY RIGHT NOW UMC IS ABOUT $15 MILLION NEGATIVE GOING INTO NEXT YEAR. LET ME PAUSE ON THAT. SEE IF THERE'S ANY QUESTIONS REGARDING THE THE FEDERAL MEDICAID DISTRICTS THAT ARE THAT ARE CURRENTLY SCHEDULED. IF THAT MONEY DOESN'T END UP COMING IN WHAT WOULD IT BE SPENT ON? I MEAN, I KNOW IT'S NOT BUDGETED, BUT DO YOU HAVE ANY IDEA ABOUT WHAT YOU'RE GOING TO DO WITH IT? WELL, OKAY. THE QUESTION BEING THAT IF THE CUTS ARE DELAYED. SO OBVIOUSLY FOR ONE, IT'S GOING TO BE ADDITIONAL REVENUE RESOURCES. AND THERE ARE THERE ARE CERTAIN ELEMENTS IN, IN THIS YEAR'S BUDGET, 2025 BUDGET THAT WE HAVE CUT THAT WE WOULD GO AHEAD AND, AND GO AHEAD AND, AND RE-IMPLEMENT. SO, SO THOSE ARE SOME OF THE ITEMS THAT WE WOULD BE LOOKING AT. BUT CURRENTLY RIGHT NOW WE'VE JUST WE'VE WE HAVE JUST TO BE CONSERVATIVE HAVE JUST HAVE NOT BUDGETED FOR THOSE ITEMS. DO YOU HAVE A LIST OF THOSE THINGS. I'M JUST CURIOUS. DON'T HAVE THEM WITH ME RIGHT NOW, BUT WE CAN PROBABLY GET THAT TO YOU IN TERMS OF WHAT? THOSE. YOU KNOW, WHAT THE. YOU KNOW WHAT WHAT THAT WOULD REPRESENT. I MEAN, THERE'S SOME THINGS THAT IN OUR BUDGET TO STAY AT A NO NEW REVENUE RATE IN LIGHT OF THE INFLATION RATE, ESPECIALLY IN HEALTHCARE. WE MADE SOME VERY LEAN DECISIONS IN TERMS OF ASSUMPTIONS. FOR EXAMPLE, IN OUR MEDICAL LOSS RATIO, WHICH HAS BEEN RUNNING HIGHER THIS YEAR. WE'RE CHALLENGING CHALLENGING OURSELVES TO HAVE A LOWER LOSS RATE IN TERMS OF THE UMC SIDE. AND THE CHILDREN'S SIDE MADE SOME ASSUMPTIONS AS WELL. I DON'T, YOU KNOW, IF IF WE HAVE THE ABILITY TO, TO RECEIVE THOSE ADDITIONAL FUNDS 20 MILLION WE WOULD, YOU KNOW, SEE ABOUT TRYING TO RESERVE FOR ME AS MUCH AS POSSIBLE BECAUSE, QUITE HONESTLY, I MEAN, WE STILL HAVE THE CHALLENGE OF THE UNKNOWN, YOU KNOW, THAT MAY HAPPEN. AND SOMETIMES IT'S WE'RE RUN LEAN IN TERMS OF RAINY DAYS. BUT WHEN YOU CONSIDER THE THINGS THAT WE STILL HAVEN'T ADDRESSED, FOR EXAMPLE, STILL ADDRESSING THE LIVING WAGE ISSUE, THAT WILL PROBABLY HAVE TO WAIT UNTIL FISCAL YEAR 26. THOSE ARE THINGS. AND THEN I THINK AS WE GO ACROSS THE UNEXPECTED, FOR EXAMPLE, IF OUR BOND WAS NOT TO PASS THAT WE'RE PURSUING, THEN THERE MAY BE SOME THINGS THAT THAT MONEY WOULD BE USED FOR IN TERMS OF HELPING US BUILD OUT THINGS LIKE THE OBSERVATION UNIT TO SORT OF DE-STRESS OUR EDITOR, [00:40:07] BUT WE CAN PROVIDE A LIST OF OPTIONS SO THAT YOU CAN HAVE THAT. THANK YOU. AT THE BOTTOM OF PAGE 25, LOOKING AT THE UMMC'S 2025 PATIENT SERVICE REVENUE. NOW FIRST THING WHEN YOU LOOK AT THE SURGICAL HOSPITAL, SURGICAL HOSPITALS ACQUIRED LAST JUNE OF 2023. IT WAS INITIALLY SCHEDULED TO START IN IN IN SEPTEMBER. BUT BECAUSE OF A LICENSING ISSUES WITH THE STATE AND ALSO PREPAREDNESS WITH WITH JOINT COMMISSION THAT DID NOT GET STARTED UNTIL JANUARY OF 2024. SO CURRENTLY RIGHT NOW IN THE 2024 YEAR, WE'LL PROBABLY HAVE REALLY ABOUT SIX MONTHS OF FULL OPERATIONS WITH JANUARY, FEBRUARY AND MARCH BEING THE RAMP UP MONTHS. BUT IN 2025 WE EXPECT TO BE FULLY RAMPED UP. AND WHAT THAT MEANS IS THAT EVEN CURRENTLY RIGHT NOW, IT'S A IT'S A 40 BED HOSPITAL AND OUR CENSUS IS ALREADY RUNNING ABOUT 30. IN TERMS OF INPATIENT BEDS. SO WE SO SO WE EXPECT TO, YOU KNOW, FOR THAT FOR THAT OCCUPANCY RATE TO TO GO HIGHER. BUT ALSO ON THE OUTPATIENT SURGERY SIDE, WE, WE DO EXPECT TO SEE A SIZABLE INCREASE IN TERMS OF OUTPATIENT SURGERIES, MAINLY AT THE, AT THE SURGICAL HOSPITAL. WE TALKED ABOUT 959 ADDITIONAL SURGERY CASES, AND THEN ALSO WITH THE NOT ONLY AT UMC, WITH THE SATELLITE ERS, BUT ALSO AT THE SURGICAL HOSPITAL. WE'RE BUDGETING ABOUT ANOTHER 3700 ADDITIONAL EMERGENCY ROOM VISITS. CURRENTLY, WE DO ABOUT 95,000 EMERGENCY ROOM VISITS, ABOUT 60 65,000 AT THE AT THE MAIN CAMPUS, AND THEN ABOUT 30,000 AT THE TWO SATELLITE EMERGENCY ROOMS SITES. ADDITIONAL INPATIENT ADMISSIONS. AS WE CONTINUE TO WORK ON OUR AVERAGE LENGTH OF STAY INITIATIVE. AND WHAT THAT MEANS IS THAT OVER THE PAST 18 MONTHS OR SO, WE'VE BEEN TRYING TO TO DECREASE OUR OUR AVERAGE LENGTH OF STAY, NOT PREMATURELY, BUT JUST TRYING TO SEE WHETHER IF PATIENTS ARE ARE READY TO BE DISCHARGED AND WHETHER THEY'RE JUST WAITING FOR AN MRI OR, OR, YOU KNOW, WHATEVER THE CASE MAY BE, TRYING TO IMPROVE THE THROUGHPUT PROCESS, BECAUSE THE SOONER WE GET PATIENTS OUT THE DOOR, THEN WE CAN TURN THAT BED OVER AND CREATE THAT INTO AN ADDITIONAL INPATIENT ADMISSIONS BETWEEN 23, 2023 AND 2024. WE'VE BEEN ABLE TO DECREASE OUR AVERAGE LENGTH OF STAY ABOUT HALF A DAY, WHICH HAS RESULTED IN ALMOST ABOUT 100 ADDITIONAL INPATIENT ADMISSIONS AT UMC MAINE. NOW, WITH THAT, WE'LL ALSO BE HAVING INPATIENT ADMISSIONS AT THE SURGICAL HOSPITAL. THAT'S WHERE THE 1300 ARE COMING FROM, AND THEN ALSO ADDITIONAL OUTPATIENT VISITS OF ABOUT 37,000. AS WE LOOK AT OTHER THINGS IN TERMS OF WHAT'S IMPACTING THE UMC AND ALSO EL PASO HEALTH, WHEN YOU LOOK AT OUR OUR ASSOCIATES CURRENTLY, RIGHT NOW, WE DO HAVE A PLAN 2% MERIT WITH A TOTAL COST OF ABOUT 5.6 MILLION, WHICH DOES INCLUDE EMPLOYEE BENEFITS. THAT WOULD BE EFFECTIVE DECEMBER OF 2024. THIS IS CONSISTENT WITH PREVIOUS YEARS IMPLEMENTATION. WE NORMALLY HAVE OUR ANNUAL EVALUATIONS IN OCTOBER AND THEN WITH THE WITH THE PLAN MERIT OF 2% STARTING IN DECEMBER 2024. AND OVER THE PREVIOUS YEARS, I THINK WE'VE HAD I THINK THIS HAS BEEN CONSISTENT GOING BACK TO ABOUT THE LAST THREE YEARS, WHERE WE'VE BEEN AT ABOUT 2% PRIOR TO THAT, DURING THE PANDEMIC YEARS, I THINK WE WENT AN INCREASE OF ABOUT 1% DURING DURING THE PANDEMIC YEARS. WE DO HAVE PLANNED MARKET ADJUSTMENTS EVERY COUPLE, EVERY YEAR. WE DO LOOK AT APPROXIMATELY ABOUT A THIRD OF OUR WORKFORCE AND AND COMPARE THOSE TO THE MARKET, YOU KNOW, PARTICULARLY WITH, WITH THE FOR PROFIT HOSPITALS, TO SEE HOW WE ARE DOING SALARY WISE. AND WE AND WE'VE IDENTIFIED CERTAIN KEY POSITIONS THAT WE DO HAVE PLANNED MARKET ADJUSTMENTS. AND THAT'S THAT WILL BE IMPLEMENTED STARTING OCTOBER 2024 WITH A COST OF ABOUT 2.1 MILLION TO ALSO INCLUDE EMPLOYEE BENEFITS. THE NEXT SLIDE WHEN WE TALK ABOUT EL PASO HEALTH A COUPLE OF TIMES, WE'VE ALREADY MENTIONED STAR. PLUS THEY START SEPTEMBER 1ST OF 2024. NOW THEY START SEPTEMBER BECAUSE THAT'S A THAT'S A STATE STATE FISCAL YEAR WHICH STARTS SEPTEMBER. OUR OUR FISCAL YEAR STARTS OCTOBER. AS I MENTIONED EARLIER, I THINK THEY ALREADY HAVE ABOUT 9300 STAR PLUS MEMBERS THAT HAVE ALREADY BEEN OFFICIALLY ENROLLED WITH EL PASO HEALTH. NOW, FROM A MARKET PERSPECTIVE, THERE'S ABOUT 22,000 COVERED LIVES WITH STAR PLUS PROGRAM AND HER GOAL WOULD BE TO AT LEAST WITH WITH MOLINA BEING THE OTHER STAR PLUS PROVIDERS AT BOTH EL PASO HEALTH AND AND MOLINA HAVE APPROXIMATELY 11,000 MEMBERS EACH. SO THAT'S SO SO THAT'S GOING TO START NOW WITH THAT, THERE'S GOING TO BE ABOUT A $195 MILLION INCREASE IN PREMIUM REVENUE, WHICH IS OFFSET BY 172 MILLION OF RELATED MEDICAL EXPENSES. SO TO GIVE YOU PERSPECTIVE IN TERMS OF THE SEVERITY OR THE THE DIFFERENCE BETWEEN A STAR PLUS MEMBER VERSUS A STAR AND CHIP MEMBER CURRENTLY RIGHT NOW, [00:45:03] STAR AND CHIP, WHEN WHEN WE TALK ABOUT PREMIUM REVENUE PER MEMBER PER MONTH THAT EL PASO HEALTH RECEIVES FROM THE FROM THE STATE, IT'S ABOUT $350 STAR PLUS MEMBER. IT'S GOING TO BE ABOUT $1,800. SO THAT'S ABOUT SIX TIMES AS MUCH. AND THAT'S JUST BECAUSE OF THE SEVERITY OF THE OF THE OF OF THE HEALTH CARE THAT THAT STAR PLUS MEMBERS NEED. SO, SO THAT'S A THAT'S A MAIN REASON AS TO WHY EL PASO HEALTH'S REVENUE IS REVENUES GROWING, GROWING BY ABOUT 200 MILLION SIMPLY BECAUSE OF THE STAR PLUS STAR PLUS PROGRAM. NOW CURRENTLY RIGHT NOW IN IN SEPTEMBER HERE IN ABOUT 25 DAYS AS THE AS THEY START BEING ENROLLED INTO STAR PLUS WE DO EXPECT THAT DURING THE INITIAL MONTHS, THREE FOUR MONTHS, THAT THE MEDICAL LOSS RATIO IS GOING TO BE HIGH AS THEY TRANSITION FROM ONE MANAGED CARE ORGANIZATION TO WAS IT TO EL PASO HEALTH. AND THAT'S STRICTLY BY DESIGN, PER THE STATE, IN TERMS OF JUST ENSURING THAT THERE'S NO LOSS OF MEDICAL COVERAGE FOR THOSE STAR PLUS MEMBERS THAT ARE GOING TO BE TRANSITIONING TO EL PASO HEALTH AND ABOUT THE THIRD, FOURTH OR FIFTH MONTH OF THAT, THEN THAT'S REALLY WHEN THE HEALTH MANAGEMENT WILL START, WILL START FOR THOSE, FOR THOSE MEMBERS. SO WE DO EXPECT THE MEDICAL OR BUDGETING RIGHT NOW THAT THE MEDICAL LOSS RATIO IN STAR PLUS ALONE TO BE 89% NORMALLY WHERE WHERE WE WHERE WE'D LIKE TO TARGET IN TERMS OF MEDICAL LOSS RATIO ACROSS ALL LINES OF BUSINESSES IS ABOUT 85%. SO SO WE ARE BEING CONSERVATIVE RIGHT NOW FOR 2025 REGARDING REGARDING STAR PLUS AND LOOKING AT THE START AND ON CHIP PROGRAMS, THE CURRENT PROGRAMS THAT THEY DO HAVE WE ARE WE DO EXPECT A RATE INCREASES FROM 2024 AND ABOUT $17 MILLION IN ADDITIONAL PREMIUM REVENUE COMING INTO EL PASO HEALTH. NOW, THAT MEDICAL LOSS RATIO FOR 2025 IS GOING TO BE ABOUT 87%. THAT'S WHAT WE HAVE BUDGETED FOR. IT'S BEEN HIGHER THIS YEAR JUST SIMPLY BECAUSE OF THE HIGHER UTILIZATION. AND THEN ALSO WITH THE MEDICAID REDETERMINATIONS THAT HAVE HAPPENED BECAUSE POST WAS A POST PANDEMIC, THE MEMBERS THAT HAVE THAT HAVE REMAINED WITH STAR AND CHIP, THEY ARE VERY HIGH UTILIZERS. SO THAT MEDICAL LOSS RATIO HAS BEEN HIGHER IN 2024 THAN THAN IN PREVIOUS YEARS. NOW, ONE ITEM I DID WANT TO BRING UP ALL THOSE THIS THIS IS 12 MONTHS FROM NOW, HHS DID RE PROCURE THE STAR AND THE CHIP PROGRAMS ACROSS THE STATE. SO IN THE EL PASO SERVICE DELIVERY AREA, EL PASO HEALTH WAS RE AWARDED THE STAR AND CHIP PROGRAMS STARTING SEPTEMBER 1ST OF 2025, WHICH IS ABOUT 14 MONTHS FROM NOW. NOW, THE THE NEW CONTRACTS HAVE YET TO BE SIGNED. NORMALLY THEY TRY TO TARGET ONE YEAR, 12 MONTHS BEFORE THOSE CONTRACTS ARE SIGNED. NOW, CURRENTLY IN OTHER SERVICE DELIVERY AREAS, THERE ARE SOME INCUMBENT STAR AND CHIP MEDICAID PLANS THAT DID NOT GET RE AWARDED IN THEIR IN THEIR IN THEIR SERVICE DELIVERY AREA. SO WHILE WE ARE HEARING IS THAT THERE COULD BE POTENTIAL LITIGATION FROM FROM THESE THREE OTHER MANAGED CARE PLANS AND OTHER SERVICE DELIVERY AREA SERVICE DELIVERY AREAS AGAINST HHS. AND THEN DEPENDING UPON THE TIMING OF IT, THERE COULD BE POSSIBLE THE STATE LEGISLATURE INVOLVEMENT ON THIS, ALTHOUGH. SO THIS IS SOME OF THE UNCERTAINTY REGARDING STARSHIP STARTING SEPTEMBER 1ST OF 2026. WE JUST WANT TO JUST TO BRING THAT TO YOUR ATTENTION. BUT HERE IN EL PASO, EL PASO HEALTH WAS AWARDED THE STAR, THE STARSHIP PROGRAM AND THE ONE. AND THEN ONE OF THE OTHER THINGS THAT JACOB WAS TALKING ABOUT EARLIER IN TERMS OF WHEN WE LOOK AT DIVERSIFYING EL PASO HEALTH, YOU KNOW, THEY'VE BEEN DOING STARSHIP FOR SO MANY YEARS NOW WE'RE INTO STAR PLUS, AND NOW WE'RE WE'RE ALSO LOOKING INTO GETTING READY FOR ENTRY INTO WHAT WE'RE HOPING A JANUARY 1ST, 2026 DATE INTO MEDICARE ADVANTAGE. SO THERE'S ALSO SOME COSTS IN HERE. RELATED. AS EL PASO HEALTH GETS READY FOR FOR FOR MEDICARE ADVANTAGE ON THE EL PASO CHILDREN'S HOSPITAL SITE. ONE OF THE MAJOR THINGS THAT IS HAPPENING THERE, JACOB MENTIONED EARLIER IS, IS THERE THE EIGHTH FLOOR THAT'S BEEN A SHELLED UNIT SINCE THAT WAS CONSTRUCTED, THAT'S GOING TO BE READY FOR FOR OPERATIONS OCTOBER 1ST WITH ADDITIONAL 26 BEDS. NOW, THIS IS A GREAT STORY TO HEAR BECAUSE HOW THIS WAS BEING BUILT IS THAT EL PASO CHILDREN'S DID MAKE A PREPAYMENT ON THEIR BANKRUPTCY DEBT OF ABOUT 10 TO $11 MILLION. SO THAT'S HOW WE WERE ABLE TO WAS IT TO PAY FOR THIS? SO THIS IS GOING BACK TO THE BANKRUPTCY DEBT. BACK IN JANUARY 2016, THE BANKRUPTCY DEBT WAS ABOUT 48 MILLION. I DO EXPECT THAT THE DEBT FROM EL PASO CHILDREN'S TO UMC WILL NOW BE CLOSE TO ABOUT 35 MILLION HERE BY BY BY SEPTEMBER 30TH OF 2024. SO THAT'S A GREAT STORY IN TERMS OF YEARS AGO COMING OUT OF BANKRUPTCY. AND NOW THAT THEY'VE ACTUALLY MADE A LOT OF DEBT PAYMENTS TOWARDS A LOT OF PAYMENTS TOWARDS THAT DEBT. THE OTHER PART, FOR 2025, WE'LL HAVE A FULL 12 MONTHS OPERATIONS. [00:50:01] MARIA MENTIONED IT EARLIER ABOUT THE MULTI-SPECIALTY CLINIC THAT'S GOING TO HAVE ADDITIONAL OUTPATIENT VISITS. AND THEN ALSO WITH THE URGENT CARE CLINIC AND THEN ON ON THE EL PASO CHILDREN'S ASSOCIATES. THEY ALSO DO HAVE A PLAN, 2% MERIT, ABOUT 1.4 MILLION. NOW THEY ARE ON A ON A DIFFERENT CYCLE IN TERMS OF THE WAS IT THE MERIT INCREASE? THEIR MERIT INCREASES ARE GOING TO BE ABOUT APRIL IN 2025. NOW, OVER THE PAST COUPLE OF YEARS AS WELL, EL PASO CHILDREN'S HAS HAD ABOUT A 2% MERIT, MERIT INCREASE. NOW, MICHAEL. SO THAT MEANS THAT IT'S A DELAYED MERIT INCREASE, NOT A DELAYED. THEY'VE ALWAYS BEEN ON A ON A DIFFERENT CYCLE THAN WE ARE. UMC AND EL PASO HEALTH IS ON DECEMBER AND EL PASO CHILDREN'S HAS BEEN APRIL. IT'S JUST A IT'S JUST A DIFFERENT CYCLE. IT'S NOT A DELAY. IT'S JUST THAT THEIR THEIR MERIT INCREASES HAVE ALWAYS BEEN IN APRIL. AND WE TALK IN TERMS OF NOW FROM THE FROM THE TAXPAYER. SO HOW SO HOW DOES THIS IMPACT THE THE TAXPAYER. NOW HERE ON SLIDE ON SLIDE 31. WE'RE LOOKING AT THE PAST SEVEN YEARS GOING BACK TO 2017. AS TO UMC'S PROPERTY TAX RATE. YOU'LL SEE IN TOTAL BACK IN 2017 23.4 CENTS. AND CURRENTLY WHERE WE ARE WE ARE WE'RE ABOUT 23.5 CENTS. SO YEAH, WE'RE VIRTUALLY AT THE SAME PROPERTY TAX RATE THAN WE WERE SEVEN YEARS AGO. YES, WE DID GO UP IN THE 20 2020, 2021, BUT IN TWO OF THE LAST THREE YEARS, UMC HAS ADOPTED THE THE NO NEW REVENUE RATE. NOW, WITH OUR PLAN CURRENTLY RIGHT NOW FOR THIS YEAR TO ADOPT THE NO NEW REVENUE RATE THAT WILL MAKE NOW THREE OF THE LAST FOUR FISCAL YEARS THAT WE HAVE ADOPTED THE THE NO NEW REVENUE TAX RATE, YOU'LL SEE IN TERMS OF ON THE DEBT SERVICE COMPONENT RIGHT NOW, IT'S ABOUT 3.8 CENTS. AND ON MAINTENANCE AND OPERATIONS ABOUT 19.8 CENTS. NOW WHEN YOU LOOK AT THE AT THE PROPERTY TAX BILL, THIS IS A SIMILAR SLIDE THAT WE'VE BEEN SHOWING IN IN PREVIOUS YEARS. WE HAVE GONE BACK TO THE LAST FOUR YEARS. WHEN WE LOOK AT THE AT THE FIVE LARGEST TAXING COMPONENTS, YOU LOOK AT EL PASO COMMUNITY COLLEGE, ABOUT 4% OF THE TAX BILL, UNIVERSITY AND MEDICAL CENTER, ROUGHLY ABOUT 8%. EL PASO COUNTY, 1415 16%. THE CITY OF EL PASO, ALSO 29%, AND THEN EL PASO SCHOOL DISTRICT ABOUT 44%. ALTHOUGH THIS LAST YEAR THEY DID DROP TO ABOUT 41%. LOOKING AT UMC SPECIFICALLY BACK IN 2021, YOU'LL SEE WE WERE AT 26.8 CENTS. WE REDUCED THAT BY A PENNY IN 2022 TO 25.8 CENTS. THAT WAS ONE OF THE YEARS THAT WE DID ADOPT A NO NEW REVENUE RATE. THEN IN 2023, WE ALSO ADOPTED THE NO NEW REVENUE RATE AT 23.5 CENTS. AND THEN 2024, OUR RATE, WE VIRTUALLY STAYED AT THE SAME RATE IN 2024 THAN WE DID IN 2023. SO WE DO EXPECT NOW ON THIS ON THIS NEXT SLIDE. LET ME LET ME TALK ABOUT BEFORE I TALK ABOUT THIS YEAR'S THE 2025 PROPOSED TAX RATE. WE SHOW THIS ANNUALLY AND THERE HASN'T BEEN MATERIAL CHANGES. BUT WHEN WE COMPARE UMC TO THE OTHER FOUR, FOUR LARGE PUBLIC HOSPITAL DISTRICTS. NOW, THIS IS TAKEN OFF OF THE THE MOST RECENT 2023 AUDITED AUDITED FINANCIAL STATEMENTS, WITH THE EXCEPTION OF UNIVERSITY HEALTH IN SAN ANTONIO, THAT HAS A DECEMBER 31ST YEAR END. ALL OTHER LARGE PUBLIC HOSPITAL DISTRICTS HAVE A HAVE A SEPTEMBER 30TH YEAR END. UMC HOSPITAL ONLY. NOT THE NOT THE HOSPITAL DISTRICT, BUT OUR REVENUE BUDGETS 829 MILLION. IF YOU PAY ATTENTION TO THE GRAY PIECE OF THE PIE CHART, OUR PROPERTY TAX REVENUE 133 MILLION, ABOUT 16% OF THE REVENUE BUDGET. PARKLAND HOSPITAL IN DALLAS. TOTAL OPERATING REVENUE BUDGET OF 3.2 BILLION. THEIR PROPERTY TAX REVENUE IS 800 MILLION, OR 25% OF THEIR REVENUE BUDGET. HARRIS HOSPITAL IN HOUSTON 2.5 BILLION. THEIR PROPERTY TAX REVENUE IS ABOUT 33% OF THEIR OF THEIR OPERATING REVENUE BUDGET. UNIVERSITY HOSPITAL, UNIVERSITY HEALTH IN SAN ANTONIO 2.4 BILLION. 25% OF THE REVENUE BUDGET COMES FROM PROPERTY TAXES. AND JOHN PETER SMITH HOSPITAL IN FORT WORTH. $1.7 BILLION IN TOTAL REVENUE BUDGET. YOU'LL SEE THAT 34% OF THE REVENUE BUDGET COMES FROM COMES FROM PROPERTY TAXES. SO WE ALWAYS LIKE TO SHOW THIS SLIDE BECAUSE IT DOES SHOW THAT THAT WE RELY LESS ON PROPERTY TAXES FOR OUR FOR OUR REVENUE BUDGET. AND WHERE THAT COMES FROM IS MAINLY FROM THE OFFICE THAT'S GOING TO BE IN THE INCREASE IN PATIENT SERVICE REVENUE THAT UMC EL PASO HAS COMPARED TO THE OTHER FOUR LARGE HOSPITAL DISTRICTS IN THE STATE OF TEXAS. NOW, WHEN WE LOOK NOW CLOSER IN TERMS OF WHERE THE PROPOSED 2025 TAX RATES, IF YOU LOOK AT THE AT THE AT THE 2025 COLUMN, THEY DO SHOW WHAT IS COMPUTED AS A NO NEW REVENUE RATE AND THEN ALSO THE VOTER APPROVAL RATE. I DO SHOW WHAT THE WHAT LAST YEAR'S RATE IS. BUT REALLY FOR FOR PURPOSES OF THIS DISCUSSION, YOU'LL SEE THAT THE THE FINAL 2023 CERTIFIED VALUES, [00:55:07] WHEN WE ADOPTED THE BUDGET LAST YEAR BACK IN LAST AUGUST WAS ABOUT 62 BILLION. BUT THE FINAL CERTIFIED VALUES THAT WERE RELEASED BY THE CENTRAL APPRAISAL DISTRICT JUST A COUPLE OF DAYS AGO. ONCE, AFTER ALL THE ALL THE PROTESTS WERE SETTLED AND AND THAT KIND OF STUFF, THAT WAS UP TO ABOUT 63.5 BILLION FOR THE 2023 FINAL CERTIFIED VALUES. WHERE WE ARE RIGHT NOW FOR 2025 IS THAT THE TAX TOTAL TAXABLE VALUE IS ABOUT 69 BILLION. SO THAT'S REPRESENTING ABOUT A 7.5% INCREASE IN TAXABLE VALUE IN 2025 COMPARED TO 2024. SO WHAT THAT MEANS WHEN YOU LOOK AT THE TOTAL TAX RATE, YOU'LL SEE THAT ON THE NO NEW REVENUE RATE THAT WILL NOW DECREASE. WE CURRENTLY ARE AT 23.5 CENTS. THE NO NEW REVENUE RATE WOULD DECREASE TO 21.9 CENTS. THE MAINTENANCE AND OPERATIONS WOULD BE ABOUT 18.5 CENTS. AND THE INTEREST AND DEBT SERVICE ABOUT ABOUT 3.3 CENTS. WHEN YOU LOOK AT THE VOTER APPROVAL RATE. THE MAIN DIFFERENCE THERE IS GOING TO BE ON THE MAINTENANCE AND OPERATIONS SIDE, WHERE YOU TAKE THE NO NEW REVENUE RATE COMPONENT OF THE MAINTENANCE AND OPERATIONS OF 18.5, MULTIPLY THAT BY 8% SO YOU CAN GET A MAX OF 19.9. SO THE VOTER APPROVAL RATE FOR THIS YEAR WOULD BE 23.3 CENTS. AND YOU'LL SEE THAT'S EVEN LESS THAN THE CURRENT RATE OF 23.5 CENTS, SIMPLY BECAUSE OF THE INCREASE IN PROPERTY VALUES. SO THIS BUDGET CURRENTLY DOES ASSUME THAT WAS IT THE NO NEW REVENUE RATE. SO IN TOTAL PROPERTY TAX DOLLARS, WE'RE EXPECTING TO GET ABOUT 149 150 MILLION FOR 2024. THAT WILL SLIGHTLY INCREASE TO 152 MILLION, MAINLY BECAUSE OF NEW PROPERTY VALUES INCREASE FROM LAST YEAR, AND THEN NEW PROPERTY VALUES THAT ARE THAT WERE COMING TO THE PROPERTY TAX ROLLS IN 2025. WHEN YOU LOOK DOWN BELOW IN TERMS OF FROM AN AVERAGE HOME VALUE, YOU'LL SEE THE AVERAGE NET TAXABLE VALUE FOR UNDER 2023 IS ABOUT $191,503. NOW THE AVERAGE NET TAXABLE VALUE IS ABOUT 205,956. SO TO THE BASED UPON THE AVERAGE TAXABLE VALUE OF 200 205,956, THE PROPERTY TAX OWNER WOULD HAVE PAID $451 IN 2024. THEY'LL BE PAYING $452 IN 2025. SO IT'S A MINIMAL IMPACT THERE IN TERMS OF THE THE OVERALL IMPACT, THE PROPERTY TAX, PROPERTY TAX OWNER GOING FROM LAST YEAR'S TAX RATE TO THIS YEAR'S TAX RATE. LET ME PAUSE THERE AND SEE WHETHER THERE'S ANY DISCUSSIONS WE HAVE REGARDING THE THE PROPOSED TAX RATE FOR 2025. ON LOOKING AT OUR DEBT SERVICE. NOW, ONE OF THE ITEMS THAT WE DO THAT WE DO USE OUR CASH FLOW FROM OPERATIONS, OUR ARE TO PAY THE HOSPITAL DISTRICT'S DEBT., SO THEY ARE BROKEN UP BETWEEN WHAT IS TAX SUPPORTED VERSUS WHAT IS NOT TAX SUPPORTED. ON THE TAX SUPPORTED, WE DO HAVE OUR OUR GENERAL OBLIGATION REFUNDING BONDS OF 2017 AND THEN OUR OUR ACCOMMODATION TAX REVENUE CERTIFICATES OF OBLIGATION SERIES 2013 AND THEN THE 2013 REFUNDING BONDS. THOSE LATTER TWO ARE THE ONES THAT ARE GETTING REFUNDED NEXT TUESDAY. SO WE DO EXPECT A LITTLE BIT OF SAVINGS IN TERMS OF THE WAS IT THE DEBT SERVICE. SO SO WHAT WILL HAPPEN IS THAT EVEN THOUGH WE MAY ADOPT A INTEREST AND DEBT SERVICE COMPONENT BASED UPON THE EXISTING DEBT SERVICE FOR 2025, IF THERE ARE SAVINGS BECAUSE OF THE REFUNDING, THEN WHATEVER TAX DOLLARS FROM THAT ARE COLLECTED ON THE INTEREST AND DEBT SERVICE COMPONENT, THEN THAT WILL BE CARRIED FORWARD TO PAY THE DEBT SERVICE FOR NEXT YEAR. SO I WANT TO JUST TO BRING THAT UP TO BRING THAT TO YOUR ATTENTION. SO THE TOTAL TAX SUPPORTED DEBT SERVICE IS ABOUT 23.6 MILLION. NOW THE NON-TAX SUPPORTED. THIS GOES TO THE REVENUE BONDS THAT WE GOT LAST YEAR FOR THE PURCHASE OF THE SURGICAL HOSPITAL. THAT WAS A $55 MILLION REVENUE BOND. ITS ANNUAL DEBT SERVICE RIGHT NOW IS ABOUT 3.6 MILLION. SO AS A WHOLE, THE TOTAL DEBT SERVICE FOR NEXT YEAR IS ABOUT 27.2 MILLION. AND FINALLY, WHEN WE LOOK AT OUR THE ROUTINE CAPITAL BUDGET, NOW, ONE OF THE ITEMS HERE THAT WE ALWAYS THAT I ALWAYS TRY TO LOOK AT BECAUSE A COUPLE OF YEARS AGO THE RATING AGENCIES DID PICK UP ON THIS IN TERMS OF FROM A STANDPOINT IS IS ARE YOU INVESTING IN YOUR ROUTINE CAPITAL? YOU KNOW, THE, YOU KNOW, EQUAL TO THE DEPRECIATION EXPENSE EARLIER YEARS, LIKE SAY IN THE 2016, 2017 TIME FRAME ON THE UMC SIDE, WE HAD HELD BACK A LITTLE BIT ON OUR ON OUR CAPITAL JUST BECAUSE WE WE DIDN'T HAVE AS MUCH CASH THAT WE DID BACK THEN. AND WE DID GET DINGED FROM THE RATING AGENCIES BECAUSE KNOWING THAT THEY'RE GOING TO SAY YOU'RE GOING TO NEED TO EVENTUALLY REPLACE SOME OF THAT, YOU KNOW, SOME OF THAT ROUTINE CAPITAL. BUT I'M GLAD TO REPORT THEY'RE CURRENTLY. RIGHT NOW, AT LEAST WITH ALL THREE ENTITIES. RATING AGENCIES DID NOTE THAT, YOU KNOW, WE ARE WE ARE REINVESTING IN OUR IN OUR ROUTINE CAPITAL EQUAL TO WHAT THE ANNUAL [01:00:10] DEPRECIATION EXPENSE IS. SO FOR UMC NEXT YEAR IS ABOUT 17 MILLION. EL PASO CHILDREN'S 6.2 MILLION. AND UMC AND EL PASO CHILDREN'S IS PRIMARILY EQUIPMENT RELATED. AND EL PASO HEALTH ABOUT 2.8 MILLION. MOST OF THAT'S MOSTLY IT RELATED IN TERMS OF THEIR INVESTMENT AND THEIR AND THEIR SOFTWARE FOR THE FOR THE MEDICAL CLAIMS PAYMENTS. SO WITH THAT, THAT IS A SUMMARY OF OUR OF THE HOSPITAL DISTRICTS 2025 BUDGET IN TERMS OF THE MAJOR COMPONENTS NOW IN THE IN THE BUDGET BOOKS THAT THAT YOU'RE HANDED OUT THERE, THERE WAS A BUDGET NARRATIVE ABOUT, YOU KNOW, 45 PAGES LONG. IT GOES INTO A LOT MORE DETAIL, BUT THE ITEMS THAT I PRESENTED WERE REALLY THE THE MAJOR ITEMS THAT REPRESENTS THE HOSPITALS, DISTRICTS, REVENUES AND HOSPITAL DISTRICTS EXPENSES. SO WITH THAT, I'LL TURN IT OVER TO THE COURT IF THERE'S ANY QUESTIONS. I DON'T KNOW YOU HAVE A QUESTION? YEAH. I'VE JUST ON THE ON THE FIRST COUPLE OF SLIDES WHEN WE'RE LOOKING AT THE INCREASE IN PATIENTS AND DAYS AND SUCH, SUCH. I JUST HAD A QUICK QUESTION. I MEAN, IS THAT DUE TO INCREASED MARKET SHARE OR OR JUST PEOPLE USING THE HOSPITAL MORE BECAUSE WE DON'T HAVE POPULATION GROWTH IN EL PASO COUNTY? IF YOU'RE LOOKING, LET ME FIND IF I CAN FIND THE SLIDE HERE JUST TO MAKE ARE YOU TALKING ADMISSIONS? YEAH. THESE ONES WHERE WE HAVE ADMISSIONS, OUTPATIENT, INPATIENT. YOU KNOW, THERE'S INCREASES ALL OVER ACROSS THE BOARD BASICALLY. AND SO MY QUESTION IS, IS THAT DUE TO PEOPLE BEING SICK OR MORE MORE PEOPLE BEING MORE SICK, OR IS IT WE'RE WE'RE WE'RE INCREASING OUR MARKET SHARE. WE'RE PICKING UP MARKET SHARE. SO FOR EXAMPLE IF YOU LOOK AT THE MARKET SHARE IN PATIENTS WITH INSURANCE, WE'RE PICKING UP MARKET SHARE. SO MORE PEOPLE ARE CHOOSING TO COME. AND I THINK IN PART, YOU KNOW, NOT JUST THE SERVICE LEVEL LEVELS, BUT WE ALSO HAVE A NUMBER OF SPECIALISTS THAT WE'VE BROUGHT IN THAT ALSO HELP IN TERMS OF PROVIDING ADDITIONAL SERVICE. WE WEREN'T PROVIDING BEFORE. OUR CLINICS ARE GETTING BUSIER AND THEIR REFERRAL SOURCE TO OUR HOSPITALS SHOULD THEY NEED IT. I THINK IN TERMS OF IT'S NOT, I DON'T THINK, A FUNCTION OF POPULATION GROWTH PER SE IN TERMS OF ACUITY, WE'RE SEEING AN INCREASE IN ACUITY. SO SOME PATIENTS COMING TO US ARE SICKER, AND THAT COULD BE CYCLICAL, BUT THAT WE DO PROJECT THAT THAT'S GOING TO CONTINUE TO INCREASE. BUT IT'S PRIMARILY MORE PEOPLE OR MARKET SHARE COMING TO US. AND THAT'S FOR BOTH UMC AND ALSO EL PASO CHILDREN'S. EL PASO CHILDREN'S BACKGROUND. YEAH. BACK AROUND THE 28 2017, 18 TIME FRAME. YOU CAN SEE THAT THEIR THAT THEIR MARKET SHARE HAS REALLY GROWN. NOW YOU'LL SEE IN ONE YEAR THAT THEIR EMISSIONS DID DECREASE TO 2943 FROM THE PREVIOUS YEAR. BUT THAT'S ALL COVID 19 RELATED. BUT YOU SEE POST-COVID YOU CAN SEE THEY'RE BACK UP TO THE 4300 SHARE AND THAT. SO YEAH, THAT'S ALSO MARKET SHARE DRIVEN. SO BOTH CHILDREN'S AND UMC HAVE GROWN SINCE 2017, ABOUT 28% IN ADMISSIONS AND FOR UMC FOR 2025. KEEP IN MIND THAT WE WILL ALSO HAVE AN ADDITIONAL 40 BEDS FOR AN ENTIRE 12 MONTHS WITH THE EL PASO SURGICAL HOSPITAL. AND EVEN CURRENTLY RIGHT NOW, I THINK THEY'RE ALREADY BETWEEN 25 AND 30 INPATIENT ADMISSION INPATIENTS AT THE SURGICAL HOSPITAL. SO THAT THAT ADDITIONAL 40 BEDS HAS IS PROVIDING TEMPORARY RELIEF FOR, YOU KNOW, FOR THE CAPACITY ISSUES THAT THAT UMC IS HAVING. I'VE GOT TO SAY WHAT A REBOUND FOR EL PASO CHILDREN'S FROM BANKRUPTCY THAT YOU WERE A BIG PART OF AS ONE OF OUR REPS TO WHERE THEY STAND NOW. WELL, I THINK MANY AND I THINK, COMMISSIONER STOUT, YOU WERE GREATLY INVOLVED IN THE BANKRUPTCY HEARINGS. I DON'T THINK I THINK MANY NEVER THOUGHT THAT THIS DAY WOULD COME. BUT WHEN THEY HIT THEIR TEN YEAR ANNIVERSARY, THEY WERE ON ON TARGET, DESPITE BANKRUPTCY TO WHAT THE ORIGINAL PROJECTIONS WERE. AND AND I THINK IT WAS IN AT THEIR TEN YEAR ANNIVERSARY TODAY, THEY NOT ONLY ARE PAYING ON THE ON THE LARGE DEBT, THEY MADE A BALLOON PAYMENT ON IT THAT WE WERE ABLE TO USE TO BUILD OUT THAT EIGHTH FLOOR SHELL FOR ADDITIONAL PATIENT SPACE BECAUSE THEY'VE RUN OUT OF SPACE. SO EL PASO HEALTH HAS BEEN VERY SUCCESSFUL, EL PASO CHILDREN'S HAS BEEN VERY SUCCESSFUL. AND UMC HAS ALSO SHARED IN THAT. AND IT'S REFLECTED IN THE GROWTH OVERALL. GREAT JOB. A VERY TELLING STATISTIC IS IN 2003, THE INSURED POPULATION THAT UMC WAS LESS THAN 45%. POINTS OUT, IS THAT UMC IS BECOMING A HOSPITAL OF FIRST CHOICE, NOT LAST CHOICE. AND THAT YEAH. AND AND STEVE IS CORRECT. GOING BACK TO I STARTED IN ABOUT 2006 AND IT WAS ROUGHLY ABOUT 5050. [01:05:07] SO BUT EACH YEAR IT'S ALMOST LIKE THAT PERCENTAGE INCREASE CONTINUES TO GROW 1%, ONE PERCENTAGE POINT EACH YEAR. NOW WITH THE WITH THE FIRST THE EARLY MONTHS OF OF THE EL PASO SURGICAL HOSPITAL, UMC MAINE HAS ABOUT A 72, 73% FUNDED PAYER MIX. STILL A LOT BETTER THAN WHERE IT WAS 5050 BACK IN THE MID 2000. BUT THE SURGICAL HOSPITAL, IT'S A IT'S ABOUT 85% FUNDED PATIENTS. SO WE'RE SEEING A LOT MORE FUNDED PATIENTS GOING TO THE SURGICAL HOSPITAL AND THAT AND THAT AND THAT PRIMARILY IS, IS IS A LOT OF LOCAL COMMUNITY PHYSICIANS ARE ARE WANTING TO DO THEIR, THEIR CASES AND PROCEDURES AT THE, AT THE SURGICAL HOSPITAL SO THAT THAT'S PROVEN OUT TO BE A VERY GOOD INVESTMENT. AND YOU AND THAT HOSPITAL IS LOCATED AT A VERY GROWTH WISE, IT'S A ZIP CODE IS 28, AND THEY'RE ALMOST ADJOINING THAT ZIP CODE. SO A GREAT LOCATION. WE'VE ENJOYED SOME GREAT GROWTH IN TERMS OF SURGERIES AND PATIENT ADMISSIONS. AND WE PROJECT ADDITIONAL GROWTH AS MORE PHYSICIANS START GOING THERE. WE HAVE SURGERIES BEING PERFORMED BY TEXAS TECH SURGEONS AS WELL AS COMMUNITY SURGEONS AND EMPLOYED SURGEONS, AND THEY REALLY LIKE THE ATMOSPHERE. IT'S A LOT EASIER TO GET IN AND OUT. WE'VE INVESTED IN, YOU KNOW, LIKE THE DAVINCI FIVE ROBOT THE MAKO ROBOT AND OTHER THINGS THAT PHYSICIANS USE AS STATE OF THE ART TO BE ABLE TO BE MORE EFFECTIVE IN THE SURGERIES THEY DO. AND ON THE THERE WERE A COUPLE OF DIFFERENT SLIDES THAT HAD PIE CHARTS WHEN THAT LOOKED AT THE OVERALL BREAK. BREAK DOWN OF THE THE REVENUE AND EXPENDITURES. SO THIS ONE. YEAH. RIGHT THERE. SO THE 1.67 BILLION. THAT'S THAT'S DISTRICT WIDE. THAT INCLUDES CHILDREN'S AND EL PASO FIRST. THAT IS CORRECT, BECAUSE YOU SHOWED US ANOTHER PIE CHART THAT HAD ABOUT 860 MILLION, WHICH WAS, I THINK, JUST UMMC'S BUDGET ONLY UMC. AND THAT'S AND THAT WAS THE YEAR 23, RIGHT? AND THAT WAS THE ONE WHERE YOU WERE YOU WERE COMPARING THE THE DIFFERENT PERCENTAGES IN THE, IN THE PROPERTY TAX REVENUE. THAT'S SO PROPERTY TAX REVENUE JUST GOES TO UMC'S UMC. THAT IS CORRECT. GO TO GO TO PASO HEALTH OR EL PASO CHILDREN'S. THAT'S CORRECT. SO THE PIE CHART THAT SHOWS 16%. THAT'S COMPARING HOSPITAL ONLY RIGHT WITH THE OTHER FOUR PUBLIC HEALTH HOSPITALS. THE BIG PUBLICS IF YOU WILL. THE OTHER FOUR THOUGH, INCLUDE PEDIATRICS BECAUSE THEY DON'T HAVE A SEPARATELY LICENSED CHILDREN'S HOSPITAL. IN OURS, WE DO NOT INCLUDE EL PASO CHILDREN'S INFORMATION BECAUSE IT IS SEPARATELY LICENSED. WHEN YOU LOOK AT AND IT'S BASED ON FISCAL YEAR 23, WHEN YOU'RE LOOKING AT OUR BUDGET, WHICH IS BASED ON WHAT WE PROPOSED FOR FISCAL YEAR 25, IT INCLUDES ALL IN THE DISTRICT. AND WHEN WE SHOW THE OVERALL DISTRICT REVENUE COMING IN 9% OF THAT REVENUE IS PROPERTY TAXES, BUT IT IS ONLY USED FOR UMC HOSPITAL. OKAY. AND THEN ON THE, ON THE ON THIS SLIDE HERE. THANKS FOR YOU READ MY MIND. I WANTED TO SEE THIS SLIDE. THE THE INTERGOVERNMENTAL TRANSFER, THE 23 MILLION. SO ARE WE GETTING FOR THE OTHER HOSPITALS AGAIN? IS THAT IS THAT WHAT THAT IS? BECAUSE THIS. YES. SO THE INTERGOVERNMENTAL TRANSFER, THIS IS THIS IS THE WHAT WE CALL THE STATE SHARE FOR FOR THE MEDICAID SUPPLEMENTAL PROGRAMS. THIS IS MADE UP FOR BOTH EL PASO CHILDREN'S AND ALSO UMC. NOW, ALTHOUGH WE DO COLLECT AS PART OF WHAT'S CALLED THE LOCAL PROVIDER PARTICIPATION FUND WHERE WE DO ASSESS AN ASSESSMENT FEE TO THE OTHER PRIVATE HOSPITALS. WAS IT HERE IN EL PASO? THAT IS NOT REFLECTED HERE AS AN EXPENSE THAT IS SIMPLY ON OUR BALANCE SHEET WHERE WE COLLECT THE MONEY. BUT THEN WE ALSO THEN WOULD THEN PASS THROUGH TO THE STATE. SO THAT'S NOT REFLECTED IN THE REVENUES AND EXPENSES. BUT BUT THAT IS A BUT THAT IS STILL A PROGRAM WHERE WE DO ASSESS A IT'S CALLED AN ASSESSMENT OF FEE OF ABOUT 6% OF THEIR RESPECTIVE REVENUE BUDGET. SO SO THAT IS WHAT IS USED TO TO FUND THE THE MEDICAID SUPPLEMENTAL PROGRAMS PRIMARILY CHIRP THE COMPREHENSIVE HOSPITAL RATE INCREASE PROGRAM FOR FOR THE TENANT FACILITIES HCA FACILITIES AND ALSO EL PASO CHILDREN'S. SO THE REVENUE GENERATED FOR EXAMPLE TO HOSPITALS OF PROVIDENCE, WHICH IS, YOU KNOW, FREE AND CLEAR AFTER THEY GET REIMBURSED FOR THEIR LPF FUND, IS ABOUT 55 MILLION, I THINK THIS YEAR FOR LAS PALMAS DEL SOL IS ABOUT 40 MILLION. SO THOSE ADDITIONAL REVENUES COMING INTO THE CITY TO THEM ARE NOT REFLECTED HERE. THEY ARE REPRESENTED IN THEIR OWN FINANCIALS, BUT IT SHOWS HOW THROUGH THE DISTRICT, EVEN OUR PRIVATE HOSPITALS ARE ABLE TO BENEFIT THROUGH PROGRAMS LIKE THIS. AND MICHAEL OR JACOB, I KNOW THAT I MAY HAVE MISSED IT, [01:10:03] BUT THERE ARE SOME TRANSFERS FROM FOR PROFIT HOSPITALS THAT ARE TRANSFERRED INTO UMC WHEN THEY STABILIZE A PATIENT, THEN BECAUSE OF NON-INSURANCE, THEN THEY GO TO UMC. DO YOU HAVE A CHART OR ANY KIND OF INDICATORS TO SHOW THAT IMPACT? NOT IN THIS BOOK, BUT WE COULD PROBABLY GET THAT. SO WE GET 55% OF THE TRANSFERS WE GET ARE FROM OTHER HOSPITALS. THERE ARE TRANSFERS THAT DO HAPPEN BECAUSE IT'S A HIGHER LEVEL OF CARE. THEY THEY ARE DEALING WITH A PATIENT THAT NEEDS A MUCH HIGHER LEVEL OF CARE, THAT THAT WE ARE THE ONLY ONES THAT CAN PROVIDE. THEN THERE ARE THE OCCASIONAL A TRANSFER BECAUSE, YOU KNOW, MAYBE THEY'RE NOT INSURED OR NOT WELL INSURED. WE CAN GET THAT INFORMATION FOR YOU, BUT THAT HAPPENS AS WELL. I THINK THAT'S VERY TELLING. AND AND IT IMPACTS YOUR BUDGET. MOST CERTAINLY. YES IT DOES. YES. I JUST WANTED TO TO THANK YOU ALL FOR FOR THE WORK THAT YOU DID ON THIS BUDGET TO, TO TO STAY AT THE, AT THE NO NEW REVENUE RATE. YOU KNOW, AS WE'RE MOVING FORWARD AND LOOKING AT THE BOND, YOU KNOW, I THINK IT WAS PRUDENT FOR US TO, TO, TO TRY TO STAY WITHIN THE NO NEW REVENUE RATE. AND YOU KNOW, I KNOW THAT I WANT, I WANT TO CONTINUE TO PUSH FOR INCREASING THAT, THAT LIVING WAGE, MINIMUM WAGE TO A LIVING WAGE. WE'RE STILL NOT THERE AT THE COUNTY EITHER, THERE. BUT AND I WOULD ENCOURAGE YOU, IF WE DO END UP END UP GETTING THAT OR IF THE, THE THERE'S A DELAY IN CUTTING OFF THE DISH PROGRAM. I MEAN, THAT 20 MILLION IF WE WOULD IF WE CAN LOOK AT POSSIBLY AN INCREASE. I MEAN, THAT'S I KNOW THAT YOU HAVE A LOT OF NEEDS, BUT PLEASE DON'T DISCARD THAT. YOU KNOW, I THINK THAT THAT'S IMPORTANT THAT, YOU KNOW, AS PUBLIC ENTITIES, WE'RE NOT CONTRIBUTING TO FOLKS HAVING TO LIVE OFF THE SYSTEM, SO TO SPEAK. THAT'S A THAT, COMMISSIONER STOUTE, THAT DEFINITELY IS SOMETHING THAT WE LOOK AT. AND I THINK IT'S OUR COMMITMENT TO THAT IS INDICATIVE OF THE CHANGES THAT WE'VE MADE, YOU KNOW, GOING FROM $10 TO $15. AND SO WE'RE DEFINITELY LOOKING AT THAT. THE BIG CHALLENGE IS THAT ONCE YOU MAKE THAT COMMITMENT, IT'S A IT'S AN ANNUAL COMMITMENT, RIGHT. AND SO WE WANT TO BE CERTAIN THAT WE'RE BEING PRUDENT WITH THE DOLLARS THAT WE'RE THAT WE'RE GETTING IN. AND I THINK IT'S A CONTINUED QUANDARY FOR US IS, IS TO HOW HOW MUCH IS ENOUGH TO HAVE IN RESERVES, AND WE'VE BEEN SITTING AT A VERY LOW NUMBER FOR A LONG TIME. AT LEAST FROM OUR PERSPECTIVE, YOU KNOW, WE'D LIKE TO BE IN A POSITION WHERE WE'RE ACTUALLY A LOT HEALTHIER FROM A CASH POSITION. BUT THEN AT THE SAME TIME, YOU WANT TO INVEST IN THE COMMUNITY. RIGHT. AND SO IT'S IMPORTANT THAT WE THAT WE BALANCE THAT. AND I'M DEFINITELY AWARE OF THAT. AND I MEAN, I APPRECIATE OVER THE YEARS YOU ALL YOU KNOW, LISTENING TO OUR REQUESTS AND DOING THAT BECAUSE I THINK IT'S IMPORTANT. AND I ALSO WANTED TO TO REITERATE MY THANKS YOU KNOW, FOR JUST, JUST THE SERVICE THAT YOU ALL PROVIDE TO THIS COMMUNITY. I WAS VERY TOUCHED BY THE VIDEO THAT YOU ALL PUT TOGETHER ON AUGUST 3RD. YOU KNOW, WE WE CAN'T FORGET ALL OF THE, THE CARE MEDICAL CARE PROFESSIONALS THAT AND THE AMAZING WORK THAT THAT YOU ALL DID IN RESPONDING TO THAT, TO THAT IF I CAN, IF I CAN JUST COMMENT ON THAT AS WELL. YOU KNOW, ONE OF THE, ONE OF THE BIGGEST CHALLENGES FOR, FOR OUR, OUR TEAM MEMBERS IS THE FACT THAT THEY'RE, THEY'RE CONSTANTLY, YOU KNOW AND SELFLESSLY, YOU KNOW, SERVING THE COMMUNITY. AND I THINK A LOT OF TIMES WE FORGET THE, THE MENTAL HEALTH AND WELLNESS IMPACT OF IT. AND ONE OF THE THINGS THAT I'M MOST PROUD OF IS THE FACT THAT OVER THE LAST, YOU KNOW, FIVE YEARS IN 2020, WE WE ACTUALLY TOOK A STEP TO PROVIDE SOME RELIEF FOR THAT. AND IT WAS SO WELL RECEIVED THAT THEN, YOU KNOW, WE'RE ADDING A SECOND, YOU KNOW, INDIVIDUAL TO HELP FOR THAT AND SERVING ON OTHER, OTHER BOARDS ON A STATEWIDE LEVEL WHERE MENTAL HEALTH AND WELLNESS IS, IS IS THE FOCUS, I CAN TELL YOU THAT EL PASO IS LEADING THE WAY. I WAS ON A CALL YESTERDAY WITH SOME WITH ON ONE OF THOSE BOARDS, AND THEY WERE TALKING ABOUT SOME WORK THAT IS BEING DONE AT PARKLAND MEMORIAL IN DALLAS. AND THEY'RE JUST GETTING TO THE POINT TO IMPLEMENT SOME OF THE THINGS THAT WE'RE ALREADY DOING. SO PASO DEFINITELY IS LEADING THE WAY. I ALSO HAVE TO REITERATE MY THANKS FOR THE WILLINGNESS TO WORK WITH MY OFFICE. AND YOU KNOW, CREATING THE GERIATRIC ED CERTIFICATION AND ALSO HAVING A GERIATRIC FOCUS ON THE THE CENTRAL CLINIC THAT'S PROPOSED IN THE BOND DOCTOR. MEENA. THANK YOU. [01:15:01] JACOB. THANK YOU TO THE OTHER BOARD MEMBERS AND FOLKS THAT HAVE BEEN WORKING ON ON US WITH THAT. THANK YOU VERY MUCH. I THINK THAT'S GOING TO BE SOMETHING THAT THIS COMMUNITY IS, IS GOING TO BE VERY PROUD OF AND NEEDS. WELL, WE'LL BE WE'RE GETTING CLOSE ON OUR GERIATRIC CLINIC CERTIFICATION AT OUR OTHER CLINICS. AS SOON AS WE GET THAT, WE'LL INCLUDE YOU AND MISS JONES. WELL DESERVED. YOU WERE THE IMPETUS IN PUSHING THAT. REMEMBER WE WE ALSO WENT WITH AND THANK YOU TO DOCTOR MEN ON OUR BOARD TO ARRANGE A TRIP AT UT HEALTH HOUSTON THAT SHOWED US THE GERIATRIC PROGRAMS THAT WERE IN PLACE. AND THAT THAT WOULD BE SOMETHING WE'RE WORKING ON. WE'RE PUSHING HEAVILY ON THE GERIATRIC ED CERTIFICATION AS WELL. AND NOW WE'RE ALSO LOOKING INTO GERIATRIC TRAUMA. AND SO HOW WE CAN ADDRESS THAT AS WELL. SO PROUD OF THAT. AND YOU KNOW WHEN YOU SEE THE VIDEO IT BRINGS BACK THE MEMORIES. I MEAN, THE HOSPITAL, THE COMMUNITY WENT THROUGH THE AUGUST 3RD MASS SHOOTING. WE ALL KNOW WHERE WE WERE WHEN THAT HAPPENED AND AND THE THE WEEKS AND MONTHS AND YEARS OF THINGS GOING THROUGH THERE. AND AT THAT TIME, OUR TRAUMA SURGEON DOCTOR SAID IN SIX MONTHS TO A YEAR, WE'RE GOING TO START FACING TRAUMATIC POST-TRAUMATIC STRESS SYNDROME BECAUSE OF WHAT EVERYBODY WENT THROUGH. BUT BEFORE THAT EVEN HAPPENED. THEN COVID HIT. AND THEN THAT CREATED EVEN A GREATER IMPACT. OUR STAFF IS THERE EVERY DAY. FOR EXAMPLE, THAT DAY OF THE AUGUST 3RD SHOOTING, WE WERE STILL OPEN TO ALL TRAUMA. WE WERE STILL GETTING OTHER TRAUMA CASES. EVERY DAY WE SEE THESE CASES, IT DOESN'T STOP. AND, YOU KNOW, OUR STAFF YOU KNOW, BY INVESTING IN THESE COUNSELORS, THESE PSYCHOLOGISTS THAT CAN MEET WITH OUR STAFF, THE THINGS WE DO IN TERMS OF IMPROVING YOU KNOW, THE THE ATMOSPHERE IN OUR COMMUNITY AND THE FACT THAT WE LOOK AT ALL LEVELS OF OUR STAFF TO MAKE SURE THAT THEY'RE PROPERLY COMPENSATED. EVERYTHING WE DO IS DESIGNED TO CREATE A BETTER WORK ENVIRONMENT FOR OUR STAFF AND PROVIDE A HAVEN IF THEY HAVE A NEED FOR ANY KIND OF COUNSELING OR HELP. AND SO WE'RE PROUD OF THAT. BUT IT IS, YOU KNOW, WHEN YOU LOOK AT THAT VIDEO AND YOU LISTEN TO DOCTOR TYROC OR SOME OF OUR STAFF, YOU REALIZE EVEN TODAY, FIVE YEARS LATER, IT'S AN EMOTIONAL THING THAT'LL NEVER GO AWAY. AND SO OUR OBLIGATION IS NOT ONLY TO PROVIDE CARE FOR OUR COMMUNITY, ALL MEMBERS, REGARDLESS OF THE ABILITY TO HAVE INSURANCE OR NOT. BUT IT'S ALSO TO LOOK AFTER OUR OWN. AND THAT INCLUDES ALL OUR MEMBERS THAT WE HAVE TO PROVIDE GREAT CARE FOR THEM BECAUSE THEY'RE AN INVESTMENT FOR US. AND THEY MADE A COMMITMENT IN OUR COMMUNITY, AND WE NEED TO BE THERE FOR THEM. AND I THANK ALL OF YOU, BECAUSE WHEN YOU THINK ABOUT THAT, WE HAD A LEVEL ONE TRAUMA PROGRAM READY TO GO THAT WE HAD THE THE NUMBER OF PHYSICIANS WE HAVE THAT WE HAD, THE STAFF THAT WE HAD AND ALL THE TOOLS WE HAD, THE INVESTMENT WE MADE IN ACQUIRING PERSONAL PROTECTIVE EQUIPMENT BEFORE COVID REALLY HIT EL PASO. ALL THAT WAS DONE WITH THE SUPPORT US COMMISSIONERS AND OUR COUNTY JUDGE PROVIDED IN THAT FORESIGHT IN ALLOWING US TO DO THE THINGS THAT HELPED OUR COMMUNITY BE BETTER PREPARED TO FACE THESE KINDS OF THINGS. AND HOPEFULLY WE DON'T SEE ANOTHER PANDEMIC. BUT I HAVE A LOT OF CONFIDENCE IN OUR TEAM AND IN OUR LEADERSHIP, BOTH AT OUR BOARD AND OUR COMMISSIONERS, THAT WILL BE READY FOR IT, COMMISSIONER, IF I MAY. GOING BACK TO YOUR COMMENT ABOUT THE TAX RATE AND ALSO TO CHAIRPERSON GALLARDO IN TERMS OF, YOU KNOW, ALTHOUGH WE, YOU KNOW, I WELCOME THE, THE RATINGS REAFFIRMATION BY THE BOND RATING AGENCIES. THEY ALL DID INDICATE THOUGH, THAT THAT THAT OUR BALANCE SHEET COMPARED TO OTHER HOSPITALS IS, IS WEAK. THAT THEY WOULD LIKE TO SEE OUR OUR DAYS CASH ON HAND HIGHER. AND FROM THAT STANDPOINT, IF WE WANT TO MOVE FROM THE UPPER MEDIUM GRADE TO THE HIGH GRADE, THAT WOULD TAKE ALMOST A DOUBLING OF WHAT OUR DAYS CASH ON HAND IS. AND TO YOUR COMMENT ABOUT THE NO NEW REVENUE RATE, I AS THE CHIEF FINANCIAL OFFICER, I'M ALWAYS AT LEAST TRYING TO KEEP UP WITH INFLATION. I WAS PUSHING FOR SOMETHING HIGHER THAN A NO NEW REVENUE RATE, AND BUT OUR BOARD CHALLENGED US TO KEEP IT AT THE, AT THE, AT THE NO NEW REVENUE RATE. SO WITH THAT, I WOULD HAVE TO THANK OUR BOARD FOR YOU KNOW, FOR CHALLENGING US TO, I MEAN, YOU KNOW, TO KEEP IT AT THE NO NEW REVENUE RATE. THANK YOU VERY MUCH. THANK YOU. THANK YOU. I JUST, YOU KNOW, OVERALL, I'VE SEEN THE BIG PICTURE. I JUST WANT TO COMMEND, YOU KNOW, THE UMC AND THE ENTIRE DISTRICT AND BOARD FOR, YOU KNOW, WE SAW THE PROBLEMS AND THE LACK OF CAPACITY THAT WE HAD WHEN THE PANDEMIC HIT. AND I'M GLAD THAT WE'VE INVESTED IN THAT SURGICAL HOSPITAL BECAUSE THAT WILL KEEP CERTAINLY WHEN SOMETHING LIKE THAT HAPPENS, FROM DELAYING SOME OF THE NECESSARY SURGERIES THAT OBVIOUSLY WERE DELAYED BECAUSE OF THE CAPACITY AT THE HOSPITAL. AND SO BUT WHAT IT TELLS US NOW IS THAT WE STILL NEED TO CATCH UP BECAUSE YOU GUYS ARE DOING SO GOOD THAT PEOPLE ARE NOW COMING TO US [01:20:09] AS A HOSPITAL OF CHOICE. AND SO NOW I THINK WE, YOU KNOW, BASICALLY BIDS US THAT WE NEED TO KEEP UP WITH THAT DEMAND TO HERE LOCALLY, TAKE CARE OF OUR CONSTITUENTS AND MAKE SURE THAT WE KEEP DOING THE GREAT SERVICE THAT YOU GUYS ARE DOING. SO I WANT TO THANK YOU ALL FOR THAT. THANK YOU COMMISSIONER. THANK YOU COMMISSIONER. THANK YOU MICHAEL. I JUST HAD A COUPLE OF QUESTIONS ABOUT THE MEDICAID DISH REDUCTION. I KNOW Y'ALL ARE BEING CONSERVATIVE. BY ASSUMING THAT THE REDUCTION, THE 20 MILLION REDUCTION IS GOING TO TAKE PLACE. BUT IS THERE HOPE? I MEAN, HOW HOPEFUL CAN WE BE THAT MAYBE THE REDUCTIONS ARE GOING TO BE DELAYED SOME MORE? I KNOW THEY'VE ALREADY BEEN DELAYED FOR A LONG TIME AND THEY'VE. OKAY. AND THIS IS MY PERSONAL OPINION. BUT I, I'M, I'M MORE HOPEFUL THAT THE THAT THE DISH CUTS WILL BE DELAYED WILL BE DELAYED PRIOR TO THIS YEAR. UNFORTUNATELY WHEN BECAUSE WE WENT THROUGH THE SAME THING THIS PAST YEAR. UNFORTUNATELY THE THE THE DECISION WAS ONLY MADE JUST TO GET IT THROUGH DECEMBER 31ST OF 2024. BUT THE CURRENT CONGRESS, THERE WAS BIPARTISAN SUPPORT ON BOTH THE HOUSE AND THE SENATE TO WAS TO DELAY THE CUTS. CUT THE QUESTION AS TO WHY DECEMBER 31ST, 2024. PROBABLY JUST POLITICAL REASONS, BECAUSE THERE'S A NATIONAL ELECTION. WE'LL LET EITHER THE THE THE NEW CONGRESS DEAL WITH IT, BUT I AM HOPEFUL THAT IT WILL GET DELAYED SIMPLY BECAUSE THEY'VE NEVER BEEN IMPLEMENTED IN THE PAST TEN YEARS. WELL, I, I HOPE SO. THE OTHER THING I WOULD SAY, TOO, IS THAT THE STATE ASSUMES UNTIL FEDERAL CONGRESS DOES OFFICIALLY DELAY THE CUT, THEY ASSUME THE CUT IS GOING TO TAKE PLACE. SO THEIR REIMBURSEMENT AND REQUESTS OF US ARE ASSUMING THAT THE CUT IS GOING TO TAKE PLACE. I THINK ONE YEAR WE MADE AN ASSUMPTION THAT IT WOULDN'T, THAT SOMETHING WOULDN'T HAPPEN. AND IT DID. AND IT WAS A VERY TOUGH YEAR FOR US. SO WE'RE ALWAYS GOING TO BE CONSERVATIVE UNTIL WE GET OFFICIAL WORD. WE'RE HOPING, YOU KNOW, WITH WITH AN ELECTION YEAR, WE DON'T KNOW WHAT'S GOING TO HAPPEN, BUT WE'RE HOPING THAT IT DOES GET DELAYED BECAUSE WE, AS WELL AS ALL OTHER SAFETY NET HOSPITALS, AS WELL AS ALL OTHER PRIVATE HOSPITALS, REALLY DEPEND ON THIS. AND SO IF IT DOES GET DELAYED, THEN WE'LL HAVE A LIST TO BE ABLE TO SHOW WHAT WE'RE PLANNING ON DOING. GREAT. AND BECAUSE IF IT DOES, IF THE CUTS DO GET DELAYED, THEN THE HOSPITAL GOES FROM A -15 MILLION TO A POSITIVE FIVE FIVE. RIGHT? CORRECT. WELL, I'LL BE OPTIMISTIC TOO THEN. FROM YOUR MOUTH. SO. THANK YOU. HAVE WE MISS SCHUMACHER, HAVE WE COME TO THAT POINT? THANK YOU. COMMISSIONER SCHUMACHER, ASSISTANT COUNTY ATTORNEY. AS A PROCEDURAL MATTER WOULD UMC OR THE HOSPITAL DISTRICT? I'D LIKE TO MAKE THEIR MOTION FIRST, AND THEN WE CAN PROPOSE OUR MOTION. YES. JENNIFER, WOULD YOU READ THAT, PLEASE? YES. MR. VILLA, WOULD YOU READ THAT INTO RECORD, PLEASE? WE'LL TAKE ONE EACH ONE SEPARATELY. AND JUST FOR CLARIFICATION, ARE WE PROCEEDING TO THE THE NEXT, WORK. WORK SESSION. YEAH. OKAY. SO GOOD QUESTION. SO I GUESS CURRENTLY WE DO PLAN TWO BUDGET WORK SESSIONS. THE SECOND ONE IS TENTATIVELY SCHEDULED IF NEEDED. SO I GUESS WE NEED TO ADDRESS THAT QUESTION WHETHER WE NEED TO HAVE THAT SECOND ONE OR NOT. DOESN'T SEEM TO ME LIKE WE NEED IT. NO. YEAH. AND STATUTORILY, WE'RE NOT REQUIRED TO HAVE A PUBLIC HEARING SINCE WE'RE NOT EXCEEDING THE NO NEW REVENUE RATE. SO WE WOULD SCRAP THE PUBLIC HEARING AS WELL OR. YES, THAT IS CORRECT. OKAY. BUT IT WOULD COME BACK TO THE COURT ON AUGUST 26TH FOR FINAL ADOPTION OF THE BUDGET, CORRECT? YES, THAT IS CORRECT. AND SO I'LL GO AHEAD AND READ THE MOTION LANGUAGE. YES, PLEASE. IN ACCORDANCE WITH TEXAS HEALTH AND SAFETY CODE, SECTION 281.096 PROPOSED THE NEW THE NO NEW REVENUE RATE FOR THE EL PASO COUNTY HOSPITAL DISTRICT, WHICH IS A TAX RATE OF $0.219526 PER $100 ASSESSED VALUE. THAT CONSISTS OF $0.185607 PER 100 ASSESSED VALUE FOR THE PURPOSE OF MAINTENANCE AND OPERATIONS, AND $0.033919 PER $100 ASSESSED VALUE FOR INTEREST AND DEBT SERVICE OF THE HOSPITAL DISTRICT FOR CONSIDERATION AND ADOPTION BY THE EL PASO COUNTY COMMISSIONERS. DO WE HAVE A MOTION? SO MOVED. AND A SECOND. SECOND. THANK YOU. WE HAVE OUR FIRST AND SECOND, MR. GALLARDO. YES. DOCTOR. MINA. YES. MR. DEGROOT. YES. MR. TORRES? YES. THANK YOU. THE MOTION, AS READ INTO RECORD BY MR. VILLA, IS APPROVED. NO. THE SECOND MOTION APPROVED THE FISCAL YEAR 2025 OPERATING AND CAPITAL BUDGET. AND RECOMMEND FOR CONSIDERATION FINAL APPROVAL OF SAID BUDGET BY THE EL PASO COUNTY COMMISSIONERS COURT PURSUANT TO TEXAS HEALTH AND SAFETY CODE, SECTION 281.091. I HAVE A MOTION. SO MOVED. SECOND. [01:25:01] WE HAVE A FIRST AND SECOND. JENNIFER. THANK YOU, MR. GALLARDO. YES, DOCTOR. MINA. YES. MR. DEGROOT? YES. MR. TORRES. YES. YOU. THANK YOU. THE SECOND MOTION, AS READ INTO RECORD BY MR. VILLA, IS APPROVED. THANK YOU. COMMISSIONERS. ANNA SCHUMACHER, ASSISTANT COUNTY ATTORNEY, FOR YOUR CONSIDERATION. YOUR MOTION WOULD BE TO MOVE TO ADD THE COMMISSIONERS COURT AGENDA AT ITS REGULAR MEETING ON AUGUST 26TH, 2020, FOR AN ITEM TO DISCUSS AND VOTE ON THE PROPOSED PROPERTY TAX RATE FOR THE EL PASO COUNTY HOSPITAL DISTRICT. DOES BUSINESS AS UNIVERSITY MEDICAL CENTER OF EL PASO. THE HOSPITAL DISTRICT HAS PROPOSED A RATE OF $0.219526 PER $100 ASSESSED VALUATION, CONSISTING OF $0.185607 PER $100 ASSESSED VALUATION FOR MAINTENANCE AND OPERATIONS, AND A RATE OF $0.033919 PER $100 ASSESSED VALUATION FOR PAYMENT OF THE PRINCIPAL AND INTEREST ON THE DEBT OF THE HOSPITAL DISTRICT. THE PROPOSED TAX RATE DOES NOT EXCEED THE NO NEW REVENUE RATE. FURTHER, AND IN ACCORDANCE WITH TEXAS TAX CODE, CHAPTER 26 PUBLISHED NOTICE OF A MEETING TO VOTE ON THE PROPOSED TAX RATE TO BE HELD ON MONDAY, AUGUST 26TH, 2024 AT 9:30 A.M. IN THE COMMISSIONERS COURT CHAMBERS, THIRD FLOOR, ROOM 303, EL PASO COUNTY COURTHOUSE, 500 EAST SAN ANTONIO AVENUE. MEMBERS OF THE PUBLIC MAY ATTEND IN PERSON OR PARTICIPATE AND ADDRESS THE COURT VIA VIDEO CONFERENCE OR TELEPHONE. INSTRUCTIONS ON HOW TO PARTICIPATE VIA VIDEO CONFERENCE ARE AVAILABLE AT. A NOTICE OF THIS MEETING WILL BE POSTED AT THE COURTHOUSE AND ONLINE AT COUNTY. THAT WOULD BE THE MOTION. THANK YOU ANNA. I SO MOVE WE HAVE A MOTION FROM COMMISSIONER STOUT AND A SECOND FROM COMMISSIONER OLGUIN. VOTING IS OPEN. I DIDN'T BRING MY MACHINE, SO I THANK YOU, SIR. MOTION CARRIES. JUDGE SAMANIEGO IS ABSENT. THE MOTION CARRIES. CONGRATULATIONS. THANK YOU ALL VERY MUCH. THANK YOU FOR YOUR SUPPORT. AND I'VE GOT TO SAY THIS JUST TO FURTHER CEMENT THIS INTO WHAT THE MEDIA MAY BE REPORTING. THIS IS A NO NEW REVENUE TAX RATE PROPOSAL, WHICH IS COMMENDABLE. AND I'VE GOT TO SAY, JUST WHAT FOLLOW UP ON WHAT WAS SAID EARLIER THAT DURING THE PANDEMIC, WE NEVER KNOW WHAT WE PREVENT. WE KNOW WHAT WE DON'T PREVENT. I MEAN, YOU HAVE IN THE HOSPITAL, YOU SEE THE STATS, BUT WHAT WE PREVENT, WE USUALLY DON'T KNOW. AND I'VE GOT TO COMMEND THE WAY YOU HANDLED ALL THIS PANDEMIC ALL THESE MONTHS, AND ALSO OUR OWN COUNTY STAFF. BETSY, WHAT A TREMENDOUS JOB YOU DID. I SAW OTHER CITIES HAVING SO MANY PROBLEMS WHERE THROUGH SOMETIMES NO FAULT OF THEIR OWN. SOMETIMES. YES. BUT HOW EL PASO MANAGED EVERYTHING. AND WE WERE REALLY ALMOST AT THE HEART OF THE COVID SPREAD. SO WE WERE VERY LUCKY. AND REALLY, I COMMEND ALL OF YOU AND YOUR STAFFS AND BETSY A TREMENDOUS JOB. IT WAS A 24 HOUR A DAY TIME THAT WE CAME THROUGH IT ALL TOGETHER. AND I JUST CAN'T BE PROUDER OF OUR OF OUR ASSOCIATION AND OUR CITY. THANK YOU. THANK YOU VERY MUCH. YOU ALL SO MUCH. AND I WOULD I WOULD JUST SAY THAT, YOU KNOW, IT DEFINITELY IS SOMETHING THAT THE WHOLE COMMUNITY CAN BE PROUD OF BECAUSE THIS IS OUR HOSPITAL, RIGHT? AND AS A COMMUNITY, WE INVEST IN OUR HOSPITAL. AND I WOULD JUST SAY THAT YOU KNOW, FROM MY PERSPECTIVE AND I THINK I SPEAK ON BEHALF OF THE BOARD, WE'RE VERY HONORED TO, TO TO BE SITTING IN THIS POSITION AND WE TAKE IT VERY SERIOUS. BUT, YOU KNOW, WHEN YOU WHEN YOU TALK TO YOUR FRIENDS AND FAMILY AND THEY TALK ABOUT THE INVESTMENT THAT THEY'RE MAKING, IT'S A IT'S A PROUD CONVERSATION BECAUSE IT IS A REALLY GREAT RETURN ON INVESTMENT FOR OUR COMMUNITY AND SOMETHING WE'RE REALLY PROUD OF, AND BEING BECOMING A HOSPITAL OF CHOICE. THAT SAYS A LOT. I'M VERY PROUD OF THAT. THANK YOU. THANK YOU. WE ARE ADJOURNED. I THINK WITH NO FURTHER BUSINESS, WE CAN ADJOURN. YES, MR. CHAIR. WE ARE ADJOURNED. ON OUR SIDE? YES. TIME IS 2:29 P.M.. THIS CONCLUDES TODAY'S MEETING AT 2:29 P.M.. WE'RE ADJOURNED. * This transcript was compiled from uncorrected Closed Captioning.