Health Safety Education and Services - Regular Meeting

Welcome back to this weekly meeting of the Health and Safety Committee with Denver City Council. Coverage of the Health and Safety Committee starts now.

My focus oh, chicken. We are on air.

There is a very odd

Alright. Here we are. Thank you. Welcome everyone to the Wednesday, 04/01/2026 meeting of the Health and Safety Committee of Denver City Council. I'm the co chair, Kevin Flynn. I represent Southwest Denver's District 2. I'm chairing for Councilman Watson who I think will be online. In fact, I believe he is online right now. Before we start with our presentation, I want to remind folks there are two items on consent that will go forward unless there's objection before the end of the meeting. And we have a presentation from Denver Health on the 2Q sales tax spending, the quarterly update.

And so I want to welcome them. But first, let me have members introduce themselves. And we now have two members online. Let's introduce the members online first in the order of your district starting with District 9.

Thank you, vice chair Flynn Darrell Watson representing the fine District 9.

And Sarah Parity, one of your two council members at large.

And for the folks at the table, because it's April Fool's Day, let me mix it up a little bit. Let me start at the far end on my right and work our way around counterclockwise.

You're freaking me out, Phil.

I know. Know. You're awake.

I'm not

sure you're gonna

be able to do this.

Amanda Sawyer, District 5. Wait.

Which way do

we go? Yeah. Which way are we going?

Oh. Now we're going twice.

David Torres, West Denver District 3.

Hi, everybody. Serenna Gonzalez Gutierrez, your other council member at large.

Last but hopefully not least, Paul Cashman, South Denver District 6.

Thank you. And seeing how well that went, I'll probably never do that again. Welcome to Donalyn and your crew, and we're looking forward to this presentation. Folks have probably had an opportunity to see it before, but the public hasn't. So please proceed and introduce your team.

Great. Thank you so much, councilman Flynn and councilman Watson, who are remote. I'm Donna Lynn, the CEO of Denver Health. Happy to be here to talk both about twenty twenty five two q spending and our 2026 spending plan. So I'm gonna turn it to you

to introduce Sure. Stephanie Seiner, government community relations. Happy to be here.

Hi, Elise Matatol. I am the Denver Health sales tax administrator within the Denver Department of Public Health and Environment supporting as a liaison between Denver Health and

the city.

Hey. I'm Justin Helsper, interim CFO of Denver Health. And

there may be questions that I turn to some of the other staff. We've got about four or five here, and we'll introduce them if they are necessary to respond to questions. Is that okay? Thank you. Great. Alright. May I begin? You're good? Alright. Let's go to the first slide, and just as I said, we're gonna break this into two sections sections because because twenty twenty twenty twenty five, five, we've closed out and we have a report on how we've spent the money and some of the accomplishments, and then 2026, we will look forward and there will there may be modifications to the plan as we go forward.

Alright. So sorry because the first slide is really full of a lot of information, but just to refresh everybody's memory, we received from the city what we call an MI payment, medically indigent payment. We've gotten that since the separation of Denver Health and the city. It has been fairly flat for many years, and I'll show you a slide in a few minutes about that. As we've seen more people coming to Denver, more people moving to Denver, more patients coming to Denver Health, and certainly the cost of health care, we've seen our, what we call our uncompensated care increase.

And that uncompensated care falls into two buckets. One is people who are completely uninsured who come to Denver Health, and we have no, way of collecting any money from the federal government from that. And then we receive a pretty significant amount of Medicaid and Medicare, and I like to use the example of if you need if you have a dollar of expenses, Medicare and Medicaid Medicaid typically pay you about 85¢. So that's an add on to the pure uninsured that we see. And so as I evaluated that, I've been at Denver Health for three and a half years and we engage with the community.

We looked at other, cities and counties around the country, and many of them have special taxing districts. They have other property tax revenues that allow them to provide this coverage. Without the support of the council and the mayor and the citizens to enact two q back in November 2024, Denver Health would have suffered a pretty significant loss in 2025 and certainly this year and future years. And I'm gonna talk a little bit, not a lot, about what is ahead of us in terms of the federal government cuts, which will really start hitting us pretty hard in 2027. We also are in the midst of working with the state of Colorado state of Colorado who has, as you know, a significant budget deficit.

And with a third of their spending being Medicaid, they are proposing a cut which we believe will be enacted any minute now, which will be a reduction in the revenue that comes to Denver Health. And that's a reduction that also doesn't take into account that we have inflation. We have prescription drugs, other medical costs plus staff costs. So we'll show you what we think some of that looks like. So during 2Q, the buildup to 2Q for us was engaging with the community and getting an understanding of what were the services that were important to the community.

And so if you go to the next slide, we just wanted to refresh your memory about the ballot language. It was a 3.4¢ tax on a $10 purchase, so just to put it in perspective, and it resulted in about $65,000,000 increase in the revenue that comes to Denver Health. We also said, and you'll hear in the presentation today, the areas where it is going to be spent. It cannot be spent on capital, for example. We can't buy, you know, build a new building.

We can staff a new building, and we'll talk about that as we go forward. So no capital expenses. It was designed to cover the operating expenses that we incur because we don't get revenue to offset that those operating expenses. And then as we developed it, we talked to the community about, you know, what are the what are the high profile areas, and the areas, quite frankly, that pay off. If you invest, for example, in primary care and pediatric care, you're gonna have healthier people living in the city, going to the schools, and so those were two of our areas.

Emergency and trauma care, you know, can impact any of us at any point in time. And then, mental health and drug and alcohol use services, we have an escalating problem as you know in not just Denver and Colorado but the country around those services and trying to get people on a road to recovery or being able to function was very important. You may remember from some of my earlier presentations, a third of our patients at Denver Health have some degree of behavioral health, mental health, or substance use problems. I like to say sometimes, although my orthopedists don't like this, anybody can fix a broken arm. It's pretty easy, but fixing, quote unquote, somebody with mental health and substance use issues is not only a longer term scenario, but also creates some moral distress for our own employees who are engaged in that work.

So you're gonna see the we are gonna be very transparent and happy to answer questions both about the methodology, but the kinds of services that we provide vis a vis 2Q. Okay. Just as a reminder, and Denver Health looks, very different if you were to do this comparison with other health care systems in Colorado. So almost half of our patients are on Medicaid, and as I said, Medicaid not only doesn't provide us today the amount of reimbursement that we need, but we are facing some real challenges going forward as the what's called HR one, the federal bill, one big beautiful bill, seeks to reduce the percentage of people that actually are on Medicaid. We estimate that about 20,000 people in over the course of the implementation of some of the h r one requirements, just in Denver, 20,000 people will lose their Medicaid coverage.

And as you can imagine, they need health care. They get health care often at Denver Health, and so they are likely to continue to seek that care. So we are very concerned about that. So that's our biggest piece of the pie is our Medicaid population, about another 20% are on Medicare, and commercial insurance is sort of typically the insurance that most of us at this table have. Our employer provides that insurance often through, you know, Blue Cross, which is now called Elevance or through Kaiser or Cigna or other plans like that.

And that's unfortunate the unfortunate scheme that we have in health care is that you charge more money to the people who are commercially insured because it helps offset the lack of federal reimbursement. Okay. Next slide. This is our uncompensated care in Denver, and, you know, we saw some significant trends post COVID, and we saw some significant trends also partly due to the migrants, but not exclusively. So, we have seen this escalation of our uncompensated care costs.

And just to take you to the legend, we do, as you are well aware, see everybody regardless of their ability to pay. It doesn't matter where they live. We see patients from 61 of 64 counties. They sometimes come to us through the emergency room, but sometimes they're just seeking care for other reasons. We've been very careful actually having talked to the mayor, but recognizing this trend even before he came into office, that we want to focus our care on Denver residents.

And we have done a number of things to refer patients back when necessary or appropriate to their counties of where they come from. So we still have about over a $100,000,000 of uncompensated care that's attributable to Denver residents, and we have seen a little bit of a stabilization and even in a reduction in what we call out of county uninsured patients. We're required by law to see Medicaid patients. If a Medicaid patient lives in Durango and comes to Denver Health, we have to see that patient. So we do have that discrepancy.

So you can see that started, when I came to Denver Health, there was one hundred and twenty million of uncompensated care, we saw that growing. We peaked, although it's a temporary peak because I suspect when we show you what this graph looks like in 2027, it will, the bar will be much higher because we'll have so many more uninsured patients. So we peaked in 2024, stabilized a little bit in 2025 in terms of the dollars that we don't get adequate reimbursement for.

Can you go to the

next slide. And you've seen this one. I used to call this my favorite slide. It's still pretty much my favorite slide, but it shows the flat line at the bottom, which is the my payment that we get from the city, and then the, you know, I'll call it the hockey stick, the escalation of our costs at Denver Health. So we are now 1 point a $1,600,000,000 enterprise as of for this year.

That's our estimate of what our costs will be. You probably know this from your own health care expenses, and health care is going up at least two times general inflation and certainly significantly above people's ages. So when we left the city in '20 excuse me, in 1996, our budget was just a shade over 200,000,000. The city was giving us 27,000,000 in the MI payment. Today, we get 30.7.

So two q was significant. The city share is about 2% of our budget, the MI payment, and then the two q is about 4% of our budget. So despite the size of Denver Health, there's about 6% of our revenue that comes from the city. We get no revenue from the state as of this year, although Medicaid does pay a portion of that. And Medicaid, as you know, is a split between the federal government and the state.

Okay. So just that was background, and hopefully it's all a refresher to things that you know and that we've talked about in the past. So I want to talk about 2025 and how we are reporting and attributing the money that we get for 2Q because transparency is very important for us. And we've worked very closely, and I wanna thank Elise for the work that she has done with us. It's really been hand in hand to try to figure out how do we report this to you in a way that ensures that you feel that we're being accountable for the money that we get.

We have to submit reports to the federal government every year. There is something called a Medicare cost report. And so we decided to use that same methodology that we use when we send things to the federal government to calculate what our spending is. So it's consistent where we are looked at by the feds who come in, the state that comes in, and so the city has helped in that ensuring that methodology works. And so we look at the services that we provide, and we know exactly how the feds and the state have accepted our methodology in the past.

And then what I'm gonna share with you in a second is how do we show that money by category. Okay. And Justin's here to help me because I already had a conversation with Daryl and he said, I don't understand what you're saying, and I said, I don't either. But I do have somebody who does. All right. So, here's how we do this. So we take a look at all the buckets. We have services that we provide, as you know, in the hospital, and then we have services that we provide in our clinics. That's our total cost, our total expenses. We divide it by our volume, which is the number of visits that we have, and then we come up with a what does it cost for each encounter.

Now, on the inpatient side, it's way more expensive than it is on the outpatient side. So an average can be a little challenging, but we can talk about, you know, depending on the services, how we split that out. And then our expenses, what we do is we're going to share with you in the buckets, in the five buckets that we have for two q, how we split that out from a dollar perspective. And in some cases, we, you know, there are direct services that we provide, so the cost of a nurse, the cost of a lab tech, etcetera. And then we also do have some indirect costs that we include, so the cost of administrative staff, payroll, security, etcetera, are built into what we call the indirect costs.

Okay, you can go to the next slide. All right, here's what starts getting dicey. That's what I'm going to see Justin. So we wanted to show you what 2024 looked like from this exam in in this example compared to 2025. And then 2025 without two q and then with two q so that you understand that even with two q, we still have some expenses that are unreimbursed.

So Denver Health is not gonna be able to say like many hospitals and health care systems will say, and there are hospital systems that last year had an 18% profit. There are some that had a 10% profit. We generally are in if we're not losing money, we're in the one to 2% range in terms of what we call a margin. We don't call it a profit. And that's partly because of the amount of uncompensated care, that we have.

So just to take you through this legend on the far right bar, The light blue column represents the money that we get through Medicare, through Medicaid, commercial insurance, and everybody else. The purple bar represents what we get through 2Q, so that's the 65,000,000, and then the striped the striped bar, that section of the bar, is what we still have as uncompensated care. So 2Q has been really important to us, but it hasn't solved the ongoing problem that we have at Denver Health. Okay. Have I got you? I got you?

Let's talk

about Alright. Let's go to the how we spent the money by category, if you can go to perfect. We had estimated along with the city that the 2Q revenue, the point three four the point three four would generate about 65,000,000. I think it's actually a little bit more, Elise, that we're we're seeing, which is a good thing. When when there is more, we get more, and we'll show you that.

And remember, we also had a conversation around the administrative expenses that the city has, and I think we're Elise is going to go through that shortly. So by category, we allocated this money through the five categories. So emergency medicine and trauma was the single biggest category where and the reason is we didn't do that arbitrarily. We looked at how much uncompensated care do we have in these buckets, and therefore we allocated the most amount of money to emergency and trauma care. And then you can see the next biggest category was primary care, the third mental health at $13,000,000 and then pediatrics and alcohol and substance use at about $2,000,000 each.

Okay, let's look at emergency care and emergency medicine. So again, looking at how much money we get from Medicare, Medicaid and from our commercial insurance, that's the on the far right bar, that's the blue section of the bar. Then the 34,000,000 that we get from 2Q is how we attribute that. And you can see in particular there's still a significant funding gap when it comes to our emergency and trauma care. I do want to emphasize to you that we do a lot of work in what we call revenue cycle.

That's code word for we have to go collect the money. And oftentimes we try to we do try and sometimes we succeed, but sometimes we don't. We do try to collect money from patients who are uninsured. We also have some discount programs and so there's a lot of effort involved in trying to make sure that we just don't say, come on in, we'll give you free care, but we are active. I don't want to say aggressive.

I know some hospitals are aggressive in trying to collect at least some portion of a patient's bill when they come in without insurance. So that remaining gap, the stripe lines that you see is actually $91,000,000 that we don't have any other mechanism to collect from. Alright. Now, what I wanted to do, and I've done in prior hearings, is also to say to you, what were we able to do with the 2Q money? Because we want you to believe, and we are committed to doing this, that we are also investing in additional services for our patients at the same time that we're trying to cover all of our costs.

So on the emergency and trauma side, there are a number of things that we did. One, there's a nice little picture of and if you haven't been in, hopefully you haven't, you don't know what this is. So if you think about television, let's think about television, and a patient all of a sudden is in the Operating Room, but then we need some kind of radiology, we need some other intervention. And the patient gets wheeled down a hall, oftentimes in an elevator. And so what this hybrid room allows us to do, and we only have one of them, it allows us to perform advanced surgical techniques that need radiology simultaneously and nobody has to get wheeled anyplace else, so you don't have that disruption in the care, it's probably also somewhat unsafe wheeling people around and wheeling people back in that case.

So we built a hybrid what we call a hybrid OR room. They're somewhat common around the country, and it was an opportunity for Denver Health to sort of bring our services up to the rest of the company country, excuse me. We also have a lot of trauma that, as you know, comes into Denver Health and we are on a path way to be a certified stroke center, and part of that is demonstrating to the people that give us those certifications that we have ICU capability, that we have all the staff that we need to be able to take people who have that kind of trauma. Right now, what we do is we send them other places, and that is not a good thing, both for the neither for the patient nor from a revenue perspective. We're also trying to we have a pretty significant residency program for trauma, but we are also bringing in fellowship, so post residency you often have a fellowship that provides enhanced skills.

And then finally, we, as you know, with our paramedics, have had some workforce retention problems based on pay. Oftentimes, paramedics at Denver Health go to other systems. They might go to the fire department, where the salary schedule is quite different. So we have what two q allowed us to do was not directly do this work, but it took a little pressure off of me and some of the demands that we have. So we were able to do a lot of things that create for the city a better level one trauma center that serves all of our residents.

Okay. We can go to primary care. Similar story, if you look at the far right bar, you can see that we spend about 158,000,000 in this bucket that actually gets reimbursed by the feds, the state, or through commercial insurance. We allocated 14,000,000, this is our second biggest category to primary care. We still have a funding gap in terms of the lack of revenue that we get in primary care.

And then there's a few things that we're doing in the primary care space that are expansions. In particular, we have expanded some of our dental services, including making them more accessible to patients through longer hours. We've also done that out at Lowry. And thank you. And we now have a Saturday clinic at Lowry.

Again, healthcare is kind of weird. Other than emergency, we think everybody should get healthcare at the same time they're working, and that doesn't always work. We luckily have other clinics that provide provide urgent care, so our Pena Clinic, we have Downtown Urgent Care, and we have a Denver Health Urgent Care location as well. And then we also built a partnership with Warren Village, which you know they have a new campus on Alameda, and we are providing health care to those individuals two days a week. We also do that at Rosendum, and we, longer term, we'll be doing that.

I think as councilman Watson knows, we will doing be doing that kind of work at Clayton Early Learning Center. So we're trying to build a system that isn't just come to the 10 Denver Health community clinics or the school based clinics, but we're also trying to embed ourselves in community based services. Okay, pediatrics, again, let's look at the far right bar which shows that we were able to collect reimbursement of 32, almost 33,000,000 in pediatrics, either fed, state, or I'm sorry, Medicare, Medicaid, or commercial. We are allocated 2,000,000 from for 2Q to help us still leaving us a gap. And then a couple of other enhancements that we've been able to do in pediatrics is we will be adding our Sandoval campus for school based centers.

We have added some additional practitioners in our school based clinics. And we do have a foster care kids program that actually tracks foster care kids' medical records. We do that out of our East Side Clinic, and we are adding a second clinic where we will be doing that program. And then mental health, if you look at that slide again, go to the far right. Reimbursement that we got that covers our expenses of about $112,000,000 coming from Medicare, Medicaid, and commercial, about 12, almost 13,000,000 from 2Q, leaving us to a pretty pretty big gap.

As councilman Cashman knows, we have a lot of problems in the mental health area in terms of recruiting staff, keeping staff, and I know many of you were at our IMAP, which I'm gonna talk about in a minute. Alright. So IMAP is the big accomplishment. We had a number of I think you're cutting the ribbon. I think you were next to me.

Correct? You were cutting the ribbon. And councilman Watson in the background, and I know a number of you have been able to tour it. Our IMAP facility is a new concept, again, to the roll you out of the OR down to a radiology suite. We were saying to people who had medical conditions, we're going take care of your medical condition, discharge you, readmit you for the psychiatric condition.

And so IMAP, we have 12 beds in our IMAP unit on the main campus, and many of our patients are complex and it allows us to take care of them in one unit. So you have behavioral health staff and sort of traditional medical clinical staff. We've served over 70 patients. We opened in December, it took us a while to get all the licensure and other requirements done, and we've served over 70 patients in that program. And then there's some other programs that we're working on on the behavioral health side that will enhance service.

And then our last category is alcohol and substance use. We get about $18,000,000 in reimbursement in alcohol and substance use. That's been a little bit of an increase from 2024. We are allocating about 2,000,000 from 2Q, which still leaves us with a pretty significant gap. And our accomplishments in that space is that we added a number of FTEs to deal with our patients that have a lot of demand in this space.

And in fact, unfortunately, we do turn patients away who come through our emergency room, our separate freestanding emergency room, because we just can't take care of all the needs that we have, particularly on the inpatient side. So, we see mental health patients and people with alcohol and substance use issues in a variety of settings, in the main hospital. We see them at Denver Cares as you know, and we see them in our outpatient services as well. Excuse me. Okay.

Every year when I put a budget together, I look at how much do we have to spend, and most of it's on the expense side, but some of it's on the capital side. And two q gave us a little relief on some of the things we have to spend on the expense side, and so we did add some additional I I had a little bit more room in figuring out my capital budget. And I think the most significant thing, and you may not know what these two little pictures are, the bottom one looks like it's COVID, but it isn't. That's that is what we use to cover up what is called our robot. We have now two robots at Denver Health.

They are used by our surgeons in highly complex surgery. I was meeting with somebody out on the Eastern Plains, a hospital on the Eastern Plains that has 25 beds, and the lead chief medical officer said, yeah, we have a robot. And I went, what? You have a robot? You have 25 beds.

We have five fifty at Denver Health and we know that our physicians who come out of medical school expect to be able to use a robot to do surgery and it's certainly safer for our patients. So the top shows you what the physician is actually doing which is watching, you know, the surgery and then there's sort of little claws that they're using to perform the surgery on the patient. So we're excited that we were able to add two of those for 2025. And I'm going to turn it over to Elise for this slide, and then happy to take questions, and then we'll talk about 2026.

Much less bright and shiny, but as part of our contract, the city is able to receive up to 1% for administrative costs. So part of our reporting is showing whether or not we actually spent the 1%, and you can see it fluctuated a little bit last year. Our original spending plan, we had proposed using the full 1%. When we came back to you in August, we said we're definitely not gonna use the full 1% and our actual was much less. So as part of our reconciliation process, when we realized that the tax revenue was also slightly higher, we included the unspent funds from administrative costs.

So I believe I processed the invoice yesterday for about 1,800,000.0 additional to go to Denver Health. Pretty simple, but happy to answer any questions.

Great. If it's okay, we'll take a pause and see if there are questions about 2025.

Thank you. Before we go to questions, I want to welcome council president. Amanda Sandoval, District 1 is online, and we have a queue started. So I'll go first to councilmember Torres.

Thank you, mister chair. Thanks, everyone. I think one of my first questions is when you anticipate or when you said you anticipate major federal cuts hitting in 2027, is it because of the reduction anticipated in Medicaid spending because they're aiming to move folks off of those roles? Or is it that and other things or just other things?

It's a couple of things. As you've heard about the state budget, which is hitting us now. So if you think about HR one, they enacted the tax cuts before they had the revenue to offset the tax cuts. So Medicaid was a big target. The target the federal government spends about 880,000,000,000 in Medicaid.

So it's a big number, and there were perhaps other motivations for trying to cut Medicaid. It had to fund tax cuts to individuals of multiples of that 880,000,000. In the state, what happened was the tax cuts that people get off of their federal income tax are tied to state income taxes as well. So the big driver there's two drivers behind the current state budget. They're spending more money for Medicaid than they thought, and they're getting less revenue from taxes.

So that's created that problem. So when I say that we are taking a looks like a 2% cut for their fiscal year beginning in July '25 '26, excuse me, That's due to their tax revenues coming down and due to the costs. The big hairy thing with h r one is that the federal government has decided that for Medicaid, there will be excuse me, there will be work requirements. So you have to work eighty hours or volunteer eighty hours community service or be in school eighty hours. And so you have to prove that.

And so we think people will fall off of Medicaid. The second is that right now, if you're on Medicaid, you come in once a year to recertify that you're you're eligible for Medicaid. So you have to show your income, and you're gonna have to show this work requirement. You now have to do that twice a year. Having met with Medicaid patients, and perhaps you know some of this, in some cases, people are forgetful.

I don't know how they're all gonna know that they have to come in twice a year, I mean, because people move and so forth. I know we're gonna do and the state's gonna do everything they can to tell people, oops, don't forget. You have to come in twice a year. But we think and all the think tanks think people are gonna fall off. The third thing is that right now, if somebody comes in I'm going use Denver Health as an example.

If I if somebody comes in January 1 and to the hospital, we try to qualify them for Medicaid. And we have ninety days to prove for them to you know, if they're they've had a heart attack, we're not doing it while they're having a heart attack. But maybe a couple days later we say, hey, you're eligible for Medicaid. How can we help you enroll? We have ninety days for that patient to fill out their paperwork, for HCPCS, the state agency, to say, yes, they're eligible and for it come to come back for us.

We have ninety days, which means April 1, I can claim that that person, that January 1 hospital stay was legitimate and covered by Medicaid. The feds, as of January '27, have shortened that to thirty days. That's gonna be really hard to meet, and we'll lose revenue because as much as we're gonna try to do everything we can, we're dependent on the patient filling out their paperwork, and we're dependent on the state processing it.

Is there a lawsuit in that somewhere?

There isn't a lawsuit on that. There's a lawsuit on everything else that is impacting our reimbursement to tell you the truth. So those three things are pretty significant. The other thing that starts happening, and this gets complicated, I'm gonna I'm gonna make it, like, simple. Extra money. We get a little bit of extra money from the feds because Medicaid doesn't reimburse us, and it's called a provider tax. The feds are going to cut that. It's 6%. They're gonna over a number of years, they're gonna reduce it to three and a half percent. What's interesting about all this is it affects every state.

So this isn't political. I mean, some of the actions that we've seen have been Colorado, we don't like you and we're gonna do this. This is every every state, every hospital, every health care provider are gonna see this, and it's gonna cause repercussions Mississippi and Alabama as much as it does in Colorado. It will disproportionately hurt Denver Health because of that slide that I showed you with us having forty seven percent of our patients on Medicaid itself. Okay.

As it relates to 2Q spend, what might be helpful to understand is what becomes carrying cost of 2Q dollars versus what were one time twenty twenty five expenditures that you don't expect to continue carrying in 2026. And I think about that internally as if you increased pay or right sized pay, that's not a one time cost. You have to continue to keep that pay up. If you establish a school based health center at Sandoval, maybe some of that is one time cost in equipment or something, but there are probably other things that are routine or become a carrying cost of that investment. That might be an interesting thing to see over time because you're going to probably allocate a certain proportion of what you see in 2Q that are just constant expenditures because in the first couple years that's what was identified to help support under compensated areas.

So just to say, I think that might be an important thing to share not just with us, but also with residents of Denver to say what's maintained through 2Q are school based clinic, A, B, C, certain things that we were able to either expand hours, Saturday hours, something like that. Or if we're able to demonstrate, we've been able to move that cost into our general fund and opened up 2Q investment elsewhere. Just something like that for the future might be interesting.

The overwhelming percentage of this is going to be salary wages and benefits, which means it's continuing. I'm looking at Justin's computer because it looks like he's got this broken out by, like, every possible category, OBGYN, you know, clinics, etcetera. So but, yeah, we can absolutely do. This is in the base. It's never gonna change, or this was perhaps a one time expense. But because we're not using this for capital, very little of it is gonna be one time expense.

Okay. That's helpful to know.

I'll make sure I'm telling the truth.

No. Absolutely. It's primarily routine costs and ongoing costs.

Okay. Thank you. And I think

to that also, we're also gonna be trying to explain more of what the inflation is because I think even if volumes stay flat, we went up a 3% inflation. So we may have seen the same amount, but the cost was 3% higher. Right? So understanding that volumes are not always going to determine that we spent more money. It was the fact that without Medicaid reimbursement and with the higher inflation, where that gap is growing. Volumes may stay level, but that gap is gonna continue to grow based off those expenses.

Yeah. Okay. Yeah.

And to Stephanie's point, I think, you know, we've had a we were we attended a meeting with you, boy, like, oh, it's over a year ago and the mayor because some of the thing a lot of the things that are happening in Washington are impacting us, which means then we say, okay. We've gotta cut services to the city, not because the city's not funding us, but because the feds aren't funding us. And how do we use our Washington lobbyists, our elected officials at the federal level to tell them the story of how this is going to impact the city. Yeah.

Okay. My last question is a little bit broader. I pulled up an article the Colorado Sun did last November about how much money hospitals are making in Colorado. And one, I wonder if it's an accurate thing, because it does sound like the researcher is charging for his report out. I don't know if it's I was someone

bomb guarded. Yeah, yeah. But two,

the report states that UCHealth made the most revenue. Dollars 6,700,000,000.0 in a single year, and they're labeled a nonprofit, so they don't pay any taxes on that revenue. So just curious in the landscape of Colorado public serving hospitals. Imbalance that you're carrying debt year over year, what do you do with that? But then two, you've got another hospital system over here making that much revenue.

What happens twenty five years from now, fifty years from now, to a system like that?

It's a great question. And a couple things. One, the hospitals do do disclose their revenue and their earnings to the state. And the state produces a report. They just, February released it, and you can literally see how much every single hospital, including small little 25 bed hospitals are making. And you can see the statement they made in this they did a webinar, was the profit the range in profits for Colorado hospitals is from negative 40% to positive 35%. Wow. I don't know how the negative 40% people are saying. We've never been a negative 40. We've been at negative numbers.

And why the heck are we allowing 40% profit? Well, you know, somebody might cynically say, well, that's capitalism. But at the end of the day, what is gonna happen is the that spread, then you lay on top of that all the Medicaid cuts. A lot of the in particular, the rural hospitals tend to be on the negative side. They're gonna close. They've already shut down service lines. So I think the accurate I think the number is in half of our counties in Colorado, there is no OBGYN. Wow. That's not really a service you travel for, particularly when you're about to give birth. I mean, maybe up to that point.

So I spend a lot of time with the rural hospitals and some of the others, and they're really they're operating on very, very, like, low days of cash on hand. And some of them, there's been some publicity in the past. Saint Vincent's in Leadville, for example, needed a loan just to be able to make payroll a couple of years ago. The interesting thing is the other the hospitals that are making a lot of money, particularly in the Denver Metro Area, will say things like, we don't ever want Denver Health to, you know, have shut down services or curtail services because guess what? The people are gonna go to those places.

On the other hand, there isn't like a helping hand program where they say, you know, if we make more than 10%, we'll give this money out to other people. It's a state enforcement might be too strong of a word because the state doesn't have any leverage. I mean, they report this.

To your Where is that report? Just so I can

I'm happy to send it to you. I'm happy to send it to you, and I can send it to the chairs Mhmm. The whole committee. So the state HIGPAF agency produces this report. Alright.

Thank you so much. Thank you.

Thank you. Council member Gonzalez Gutierrez.

Thank you, mister chair. Thank you all for all of the information and the work that's being done, and I know we're still gonna go into the 2026 part as well. Okay. So I'll hold any questions on that front. Going to the pair mix slide.

Mhmm. A little pretty pie chart. So it shows the revenue 1,560,000,000. I'm curious where could we find the MI and the two q and any other, like, payments from the state that are oh, I lost it. That are accounted for in that pie chart.

So because it has this broken down, like, you know, we don't have it up on the screen, but oh, there it is. Okay. Yeah. So where would we find those other revenue sources?

Yeah. No. Great question. So the 1.5 it's included in the 1,560,000,000.00, but it is not a payer necessarily in in the traditional sense. So it's not like a Medicaid or a Medicare or anything like that. So that pie graph is representative of true payer sources that we get on an individual patient when they come in the hospital.

So then if this says payer mix and this is the 1,560,000,000.00, but the 2 q

So 95,000,000,000.

95

MI payment. Excuse me. Yeah. 95,000,000 Uh-huh. Would and and it's a good point. We Like, have a way to incorporate it. Yeah. So it's as I said, it's equal to 6% of our revenue now. And I think do we include it on the

my favorite chart? It's it's a lot. It's I mean, it's it's because it's so small, it's the 6%. Right?

It's on yeah.

That one? Yep. It's the green arrow.

But and so this is the operating expenses. Right. Not the revenue.

Right. Yep. No. I think you bring up a good point that on this chart, even though it's not a traditional payer, that we can show that 95,000,000 as of as a revenue source.

So the 9 that is incorporated. That that amount on that chart is 1,560,000,000.00. The 95,000,000 is is taken into account in that number. Yes.

Is that

what you're saying? Okay. That's helpful to know. I just was like, wait a minute. We're missing something. So yeah. So maybe we can figure out how to We

can display it. That and on the That would be line grip.

And I think that's I think that was, like, the main one here. I might have other stuff for the 2026, but let me just double check. I'm switching between the wrong windows. Oh, yeah. The the on the fund unfunded gaps. So as you walked through kind of each of the sections and, again, I appreciate you all, like, reaching out and us being able to have conversations around all of this. Just curious what beyond, like, payer reimbursement, what funding fills these gaps? Are there other funding sources that you all have access to or that you're generating any revenue from to fill those There

are some. What we mostly do is we can bill, although we don't have go back to the pie chart. We try to bill the commercial insurer to offset some of these costs. The problem is we don't have enough commercial patients that come to Denver Health to be able to do that. So it either becomes we bill like I use my example, we need a dollar. Commercial payer gets billed a dollar 30. Mhmm. Or we simply suffer a loss in that particular bucket.

And maybe we need to build out this payer mix a little differently, because I think really the payer mix slide is to show how much we have gap. Right? So if you look at the 47% doesn't get full reimbursement, self pay, you know, self funded. So you're at already 60, almost 75%, 80% of of services that we provide that are not reimbursable. Right?

So I think to your point, maybe we need another graph to show where the that 90,000,000 and showing the uncompensated care. Right? Because it's still a large pie that's still not covered, being that it's only 6% of the total budget. Right? But this really was to show like, this actually shows huge gaps of where we're not getting reimbursed at all and and why that gap continues to grow.

We do also get grant program programmatic grants from the federal government, sometimes from the state from CDPHE that help us provide services. They're not significant, and in fact, particularly the federal ones have been cut back under the current administration. Some of our public health services get funded by grants. Were you standing up to say that?

Doctor. Steve Fedico, Chief Government Committee Affairs, members of the committee, thank you. I might say it a little differently. I think probably have two graphs. One, that this is payer mix, standalone. The second might be all sources of revenue that come to Denver Health, and that would be separate. I think that's what Donna's alluding to, a contract that we get the operating agreement. A lot of times it's cash in, cash out because it's specific to certain things, but it is still a revenue source in the traditional sense. So I think they're two different ones. As you look at the payer mix itself, as Donna articulated earlier, in the Medicaid portion of the pie, dollars $0.01 5 out of every one of those dollars are going to be represented in the uncompensated care.

100% of the self pay or nearly 100% of the self pay would be represented in those uncompensated care. So 2Q is going to be spread out between Medicaid and self pay in that chart. But I appreciate the point, and I think we need two different pies to get to your point. So thank you.

That sounds great. Alright. That's all I have. Thank you, mister chair. Thank you all.

Thank you, councilwoman. That was exactly gonna be my question because I was confused by that chart. Where's the 2Q? Where is it? Maybe on the on the subsequent reports, we could have a lot more clarity and include that upfront and maybe not a pie chart, but an actual table showing the Okay. Showing the dollar amounts. That'd be fabulous. Next up, have council councilmember Parity online.

Yep. Hi there. Can you guys hear me okay?

Yes. Yes.

Great. Hopefully, my son will not join me because then you may be hearing all kinds of noises that are not related to health care or Denver Health. So far so good, though. So I wanted to go back to the slide that the really helpful slide that has the boxes on how we're thinking about where 2Q money goes and that we're basically looking at a cost per visit kind of model for that. And it would be helpful if we could put that back up, think, if that's possible. I'll get the producer a minute for that. I don't remember the slide number, but the one with all the boxes. It's nine. Slide nine?

Yeah.

It just needs to share on the screen.

Yeah, if it's possible to

get it

on the screen. If not, that's Okay. But my question about it is really, would like to know more about what's in the blue and yellow boxes, I think, like what contributes to the total cost of a visit. And the reason that we have so many questions about this yeah, this one. So the inpatient total costs and the outpatient total costs or really, yeah.

So I'm trying to get my head around what feeds into that in the same way that we're trying to get our head around the other income streams that you have that are not linked to particular patient visits, you know what I mean? Because in healthcare world, everybody thinks about this in terms of how a visit is paid for, like that's very natural in the world of healthcare. And then for what we usually are budgeting for and how we look at our city budget, it's completely foreign, you know? And so I just think for us, like, that model makes less intuitive sense, and it's a good way to look at the Duke Q money because it helps us think about making sure that people in Denver are getting cared for. I like it as a way to view this, so don't get me wrong about that, but I think it gets to feel I get a little bit confused by, like, how we think about, for example, things that are separately grant funded or things like that.

And there's no probably perfect model of a way to do this, but I would love to understand a little bit more about those boxes. And then and I don't think that's probably a right now kind of answer. So then the other thing is, I know there's been a little bit of conversation back and forth about kind of quality metrics. And Denver Health, from my experience and everything else, is an exceptionally high quality place to get health care. But I would love for us to talk a little bit about, could we get improvements on wait times for some of these really challenging services?

Or could we see what those are as time goes by? Like, how long is it taking someone to get seen for addiction health care? All those kinds of things would be amazingly valuable to counsel, just to know what kind of track we're on. And I'm sure you all have thought about that, so I'd love to hear more about how you're kind of measuring what you're able to provide in these in these different buckets. And I you know, the 2 q dollars are both really helpful, and they're not, like, earth shatteringly large numbers within the budgets for these areas. So it's not as though they can completely transform what you're doing. I think you're spending them very wisely, but I would love to know more about what your thoughts are about relevant kind of quality metrics that could be shared with us in these categories as well.

Sure. Donna, we're happy to do that in a subsequent report. So we measure access, meaning time to first appointment, we measure average wait time, we measure we have waiting lists for some services, so all of that we collect. We also do surveys of our patients after they have a clinical outpatient clinical visit. They get a survey.

That is called CAHPS, c a h p s. And we are the federal government requires us to do that for Medicare, believe it or not, not for Medicaid. We also collect clinical indicators that are on the ambulatory side might be the percentage of patients who have hemoglobin a one c of less than eight. We have hospital indicators that are required by the feds c as well and our state agency requires us to provide a lot of that information. So and we have it in our health plan.

So we got a lot of data. We could show you, and we can show you, and maybe we'll just work on three or four indicators that we use to measure both effectiveness and availability of care.

And, councilman Parady, Alisa and I have had this conversation as well because we've we took the feedback from the last meeting. We have actually asked for an extension for the end of year report for this year so that we can, ensure that we're putting the right metrics in the final end of year report to be consistent from now until forever. And so we will be working through those this next month. We also talked about overlaying report to the city because the operating agreement requires it to the city at the end of at the May. And so how can we make this a next chapter for that?

Right? And so it's we're not duplicating any efforts, but we're adding a new two q chapter to the report to the city with some of these quality metrics. So thank you for the feedback. We'll add some of those that you put in that maybe we haven't thought about into that end of year report.

Okay. That's amazing. And I think like the again, I know you clearly you co opt and calculate so many of these different things. And so the question is kind of like anything. I think we would be really grateful for just more of that information.

And even if that meant including it in the report for 2Q, I think is in a thoughtful way, really great because of that repeated element of it over time. But I also would say that if you have reporting that you've done for other levels of government and you just want to share it with the members of the committee, I'd be thrilled by that. You know what I mean? So some of it doesn't need to be re slicing and dicing things that you've already done. I just I personally am so curious about, especially in the area of behavioral health and addiction treatment, where we have such backlogs and so much catching up to do, I'm grateful to see information.

Do you want to talk a little bit about the total cost?

I think she wants us to do it separate. Yeah, if

you have something you want to say, that, feel absolutely free. But it seems like maybe more technical than it seems like maybe more written information than verbal information is my guess. But feel free if you did have something you wanted to say about it verbally.

No No worries left with the

Yeah. That makes sense to me. Okay, thank you so much. Those were my questions. Thanks, Mr. Chair.

Thank you.

Thank you

all for me. My duty, BHG, and Denver Health, tons of work has gone into this. And it's really cool to have this way to work a little more closely together. So I'm so glad we passed the tax.

You. Your son has no questions for us?

Well, he does, but he's been banished.

Just a second. Thank you. Council member Cashman.

Thank you, mister chair. If we can go back to Donna's favorite slide. You know, it's really a basic question. So the 30,000,000 that was 30,000,000, remain 30,000,000, is still 30,000,000. What is your understanding? What is the purpose? Why is the city paying any money at all that happens to be that $30,000,000?

Well, I mean, twenty eight years ago when or not twenty nine years ago, I guess now back to 1996, '97, that was embed that's embedded in our basic operating agreement with the city. I believe the language and I've got my lawyer here, but it is, you know, this amount shall be increased, you know, from but based on the two sides agreeing, and so the two sides don't always agree.

But I mean, Donna Donna, why are I mean, why was money at all?

Well, because the recognition that we have Denver Health had uncompensated care. Back in '20 and sorry, in 1996, you know, that was equivalent to 12 the 30 the what was 27,000,000 back then was pretty significant because it was more than 10% of our budget. Over time, it's turned into an me, I appreciate the 30,000,000, but it is such an inconsequential amount compared to the amount of uncompensated care that we provide because it hasn't kept up with inflation. It hasn't kept up with more people living in Denver since 1996, more people coming to Denver Health, and then the cost of health care escalating five, six, 7% a year. I mean, health care nationally this year increased 8% over last year.

It is increasing at a rate of 8%. So this was intended to recognize that the city, I assume, and its budgeting process every year would say to the agencies, police department, parks department, Denver Hill, you can have a little bit more because we know that you have to pay wage increases and you've got other issues. And that really negotiation, and I've been involved in four years now of negotiations, it's it's not even really a conversation. I mean, the fact that we have to pay wage increases, and I know the cities had some constraints as well, is not factored into this this payment. So the expectation is we go get that money from our other payer sources, Medicaid, Medicare.

And as I said, in the case of Medicaid this year, they're not even they're not giving us an increase. They're actually cutting. So the net result of what will happen to us from a Medicaid perspective, that 47% is we're basically gonna take a five to 6% cut because wages went up by 3%. The state's gonna cut us by 2%. So inflation should have driven an automatic increase in the cost of living.

And councilman Cashman, the the intent when they split was so that Denver Health could thrive and grow because the mission is to serve and to take any patient regardless of their ability to pay. So that was the original intention from the city splitting, was to allow Denver Health. But they knew that with the mission and it being a public institution as it was when it was at the city, uncompensated care would still be an issue. So the city agreed to carry that to help offset that cost because we knew that we were taking care of the most vulnerable populations. So I don't ever think that the city realized that it would grow to as large of an institution as it has, and that the way that the formula was put in did not allow for that inflation in the city budget.

So I think that's why the city has allowed it to be flat, even though the cost and the amount of people we're seeing is continuing to grow. So the language in there was with good intent to make sure that we could continue to see those patients and the most vulnerable that were residing in Denver.

But if I were there in 1996, I would have said we need we need a cost of living adjustment or we maybe even need a mediation. We need something because the and this is not this administer I mean, this goes back, as you can imagine, to four different administrations. The recognition that there's not a cost of living, it's always been, you know, we have we have resource constraints ourselves as the city. But usually, when you have a contract with somebody, you have a cost of living adjustment, and we don't have that.

That. Yeah. I think it's embarrassing. I think the city's ignoring its obvious responsibilities to do a better job of supporting Denver Health.

And at a certain point, you know, this chart ten years from now, whoever's here, that line is gonna be two and a half billion, whatever it is. And so $30,000,000 on 2 and a half billion becomes even more more inconsistent. Yes, sir? It's actually

a staff member, but just if I can interject, we have two other folks in the queue and we have another section of the presentation to go. So if we could speed up the beef, it'd be good.

Thank you. Just ask one question. Yes.

Thank you. Are you done? Yep. Thank you.

Can I

just jump in

really quickly? I know council member Watson's in the

queue, this actually attaches to council

member cash funds.

I was just gonna say I did a calculator on AI. Purchasing power of the dollar, has had a cumulative price increase since 1996 to today of a 108.28%. The value of $30,000,000 today in 1996 would have been 62,480,000.00.

Was how much?

62.48.

Thank you. Was was that your only question?

That's it. Okay.

Council member Watson, go ahead.

Thank you so much vice chair and thank you so much CEO Donnellyn. I'm going to say I'm going to rely on Doctor. Federico and Stephanie to keep you off of that robotic arms, so you're not doing surgeries with. One question, if 2Q didn't pass, can you kind of share a little bit as to opine a bit? I know you shared kind of the benefit. Share for folks who are watching kind of what that impact from your perspective would have been if 2Q did not pass in an environment that we're currently in?

We we Running operating deficits, and you can only run an operating deficit for so long. It's going out of business strategy, or it is a let's make decisions about what clinics to close, what services to curtail, and we're that's a scenario we're doing now as we think about HR one. So it would be service reductions that would impact patients who, you know, as I said, the other hospitals don't always wanna see our patients. And, of course, we would see people getting sicker and then ending up in the emergency room because they didn't get, you know, an immunization or they didn't get, you know, some basic preventive care. So it would it was a it was a potential going out of business strategy if we didn't have the 65,000,000, and I think some more difficult discussions with the city about whether or not that 30.7 could go up and I know the city's budget isn't gonna allow for that.

Thank you, CEO Lynn. Thank you, vice chair and council member Cashman. I'm with you a 100%. No no further questions.

Thank you. We could go on to the next section, but I did have just one quick question on the first on 2025. The sixty five million dollars allocation from 2Q for 2025, did the end of year reconciliation show that that was that you should have had more than $65,000,000 or less? I can't tell because I looked ahead at we're giving you a 4%, a little over four percent additional 2Q money in 2026, and we didn't project a 4% increase in our budget. So can you clarify? Sure.

It showed and, Elyse is our partner on this. It showed that we, I wanna say, I don't wanna say should have had more. You know, the sales taxes, you know, fluctuates from month to month. Right. And when you look back, we decided to be conservative, and I think the number we used was 64.8. Was was that the number that we used? So we budgeted 64,800,000.0. It ended up being, as Elise said, both 67. 67. So combination of the sales tax revenue was higher, and the administrative expenses were lower.

Yeah. It ended up being 65.8 for the revenue last year, 2025. So we just paid them 1.8 more than because the difference it was about 1,300,000.0 higher than the original estimate, which we used to set up the tax lend.

So was that makeup included in the 2026 allocation, or was that added on to 2025 books?

So did discuss this. Yeah. So that's something that we we need to discuss a little bit more. We discussed it yesterday because it actually shows in the city that it was closed out in the 2025 Right. Books. And so we need to discuss whether or not that can be applied to 2025 of our uncompensated care. So it would just be an additional 1.8, and then we would just need to show where we put those funds because it it won't reconcile correctly with the city if we add it to the 2026 budget. Right? Because we've already been paid for that. And if the if the sales tax decreases and we have to reduce, we don't want those to mix up. Right?

Right. Thank you, Stephanie. I and I would suggest that that's the way that makes sense to me. It's 2025 money Right. Which would be accrued to 2025 expenses. So we'll we'll make a little better there.

Yeah. We'll get an update with once we figure out that because it's the first time. Right? So we're like, oh, what do we do? But I think it's gonna be cleaner if it sits in the 2025. So we'll we'll get that explanation out as soon as we we get it cleared up. Yeah.

Let's move on to 2026.

And I think I can do this in a couple of minutes. So our overall goals, as you know, in addition to being accountable by those five clinical areas of pediatric care, primary care, emergency and trauma, and mental health and substance use is, particularly as Councilwoman Parady and Councilman Watson were referring to, we have to be financially sustainable. That's sort of that's the table stakes because otherwise we then cut services. And to the questions around councilwoman Parity's questions around quality and access to care, that clearly is also a priority. We also look at where where's where are we feeling the demand from our patients?

And clearly, mental health and substance use is one of those. As I said, in our inpatient setting, unfortunately, we have so many people flowing into our psychiatric emergency room, and we don't have the beds for them. They we often refer them to other facilities. And we would prefer not to do that because other facilities don't always have the medical and psychiatric services. So we know that's a high demand area.

It's also a low reimbursement area. So if you look at the next slide, our estimate for the 2Q revenue is up a little bit. It's $67,700,000 And then there's just a marginal increase. So we've taken the 2Q money and spread it pretty consistently with what I went through. So again, emergency medicine and trauma care getting about $35,000,000 primary care the second highest area, and then mental health the third.

So, on a percentage basis, about 51% of our 2Q money goes to emergency medicine and trauma, 20% for primary care mental health, and then it's 3% each for the other two areas. And if you go to the next slide, areas. I mean, we're a quarter of the way into 2026, but part of our obligation is to tell you and tell the city how we're we plan to spend the money. And you can see the various buckets. We want to continue to expand the services we have in our emergency rooms, in particular psych, but across the board.

Primary care, again, more service expansions. We will be able to finally, Councilman Cashman, who I think you will see our new clinic on, Evans And Monaco tonight. We will begin seeing patients during 2026, both primary care and specialty care, so yay. When we open up the clinic on the West Side in Councilman Torres' district, we're not spending 2Q money to build it, that's vibrant Denver money, but in 2027, some of the expanded staffing in West Side will be covered by 2Q. So a variety of things that we're going to be doing, and then I think my last slide that I can cover, and then I'll turn it to Elise in terms of the city expenditures.

That Medicaid flip is in 2026. Well, we've seen some things in 2026 already. We do know that there are patients who are staying away from health care partly because of immigration issues, but I think a lot of confusion around Medicaid. Cover All Coloradans is a state program that provides coverage for undocumented individuals but who live in Denver. You have to live in the state.

You can't be from someplace else. But Cover All Coloradans will be cut, we believe, by the state in, you know, the tail of their years, that's the last six months of our calendar year. And we are worried that we're seeing higher patient acuity because people are just not getting they're not they're not voluntarily going to a clinic because of fear of being taken away. So I will turn it to Elise to go over how the city is gonna spend its money and happy to take questions about 2026, but we'll be back in August in August to sort of give you a more complete picture of what we've spent in the first six months of this year.

Great. Thank you, Donna. Similar to the last slide that I presented, this is our proposed spending plan. So similar to Denver Health, we have a proposed spending plan of how we plan to spend our 1%. So you'll see we're breaking it up by administrative expenses related to personnel.

So that would be my salary, half of a fiscal administrator who supports some of the contracting and invoicing, some leadership time to account for that, and services and supplies, which are ambitious to make sure we have the ability, but likely will not spend all of them. And then a large funk a large chunk is related to a subcontractor that we've been working with Third Horizon that has been really helpful as we've been developing some of these conversations thinking about what does reporting look like and how can we do meaningful reporting. So that's been very helpful for us. Similarly, we will not likely spend the full 1%. We have the ability to spend about 670,000, but we're we'll not likely do that.

We will update in August and see if we're on track, but we will likely have a small amount that we'll get back to you again next year.

Any questions?

Is that it?

That's it.

Thank you. No one has joined the queue. I'd like to invite questions. Let me ask. Okay. Go ahead, council member Sawyer.

Oh, thank you. I just I don't have a question.

I just wanted

to say thank you. I really appreciate all of the work that you guys are doing. I also appreciate the stressful financial situation that you're in with all of the changes that are coming. I'm very concerned about 2027, but really appreciate the transparency. Think with, you know, with residents' tax dollars, city tax dollars, we need to be extra careful to make sure that we're sharing the information on how these dollars are being spent. And this presentation was fantastic. The information that you provided was really helpful and I think very really, really clear. And I just wanted to give you that feedback because I think you guys did a fantastic job. So thank you.

That's

it. Thank you. Councilwoman Gonzalez Gutierrez.

Thank you, mister chair. And, yeah, thank you all again for the partnership and the work that's being done. And I know, you know, we're still, you know, it's fairly new, and I know there's a lot of places that we're recognizing that we can see a little bit more information, a little more transparency, but I really appreciate the willingness to come to the table and figure that out and how to best present the information. And I couldn't agree more, you know, with with my colleagues as far as the funding goes, but that also begs the question of there's there's there's a there's a number of, like, out of county, right, patients that are seen as well. And, you know, knowing that there is some money nor was money coming from the state, right?

I'm not sure how that's gonna look going forward, but, you know, then the question is also, and I think this has been discussed before is how what are there are there other ways to also partner with other counties as well knowing that you are the safety net hospital, and how do we make sure that, you know, that doesn't go away? Right? And that is on all of us. Right? And Denver carries a significant portion, but there could be some partnership, maybe additional partnerships happening there and shouldn't just all be relied upon Denver as well.

But I do agree, like, we need to really figure out, you know, where where else are we missing some funding sources. The the question that I have on just on 2026 and the I know councilwoman Parity brought up the quality metrics. And I guess, did and maybe I missed this and I apologize, but do we know when we will see kind of that a little more detailed out and in a possible, like, the spending plan addendum? When will we see that for 2026?

For '26? Mhmm. We'll we're working on closing out '25 metrics. And so I think once we have that solidified, then we can show you the projection for '26. So maybe we can get that out just for you all to look at once we get the report. And then in August, when we come back to do the spending plan review, we'll we'll have those as part of our presentation. Yeah. So I think maybe by summer, we'll be able to get you what the projection for the metric stuff is for '26, and then we'll have an end of the year report by May.

Okay. Okay. Great. Thank you. Thank you, mister chair.

Thank you. On the on the new clinic in council member Torres' District 27, what's the amount of the vibrant member funding? And that doesn't I'm sure that doesn't cover the entire capital cost. What's the what's the remainder of the capital?

So we anticipate a hun excuse me, 100 to 115,000,000 is gonna be required to build the clinic. And so we're building the clinic on a parking lot, knocking down the old clinic. So somewhere between 100 and 115,000,000 depending on labor costs and, you know, supply chain and all of that. Vibrant Denver gave us 20,000,000. I'm grateful, but I'm also disappointed. And I'll tell you why. Because the outpatient medical center that we built in 2022 that was funded by a city bond covered half of the cost of the bond of the, excuse me, of the facility. So 75,000,000 of a $150,000,000 was through bond.

You would have to be in a very long line to be in the club of people who are disappointed in their vibrant allocations because the peanut butter was spread extremely thin. I don't think any I can't think of anything that was fully funded. Too many needs, too little dough. So does any of the two q money I know you can't spend that on capital, but does any of that is any of that money eligible to assist you with project oversight or does that have to come out of the capital fund?

I think that all comes out of the capital. The but the operating cost, so we will when we rebuild it, we're rebuilding it at a significantly larger footprint and adding services. So some of those services can be part of 2Q. Okay. We're doing those in '26

or during the '26, at to opening of the clinic Okay. I wanted to clarify that there's a wall between Yeah. This is all capital, so any expenditures that Denver Health might make in project oversight is strictly out of capital side.

That's correct.

No assistance from 2Q. Okay. Thank you. I don't see any other questions. Going once, going twice. Thank you very much. Thank you. Very much appreciate the presentation and we'll see you in another quarter.

Thank you.

Two items go forward on consent and we're adjourned.

Thank you.

I just get a text