Public Health Trust Board of Trustees - Regular Meeting

do do Thank you.

Thank you.

Thank you. Thank you. Thank you.

Past Chair Amadeo Lopez-Castro. Past Chair Amadeo Lopez-Castro. Calling Past Chair Amadeo Lopez-Castro. Before we call the meeting to order, we wanted to recognize a special person that's in the audience. Amadeo Lopez Castro, the third, fourth, the fourth.

Welcome.

Welcome. All right, well, we'll go ahead and get the meeting call to order. Reverend Kelly's not with us this afternoon, so we've asked Dr. Richardson to lead us in the invocation.

A theologian by the name of Brian Holt Huber wrote a prayer about 100 years ago and it's become an international favorite and I think it's appropriate for this time that we consider this prayer. Join me. God, grant me the serenity to accept the things I cannot change, the courage to change those things that I can, and the wisdom to know the difference.

This is the opportunity for the public to be heard. Is there anyone?

Okay, thank you, Lourdes.

The first item on the agenda is the approval of the minutes from August 27th, 2025.

So moved, Madam Chair.

Is there a second?

Second.

Okay, all those in favor?

Aye.

All right. So we will call the purpose of this meeting is really to review the proposed budget presentation. Zuzel Jimenez, Associate Vice President of Budget Financial Planning and Analysis, will present the budget as is required by Miami-Dade County.

Thank you. Good afternoon. Thank you for the opportunity to present Jackson Hill System proposed fiscal year 27 operating capital budget. I will start with the key volume assumptions supporting our operating budget. For fiscal year 27, we anticipate that overall patient volumes are going to remain stable while we continue to see growth across several Jackson strategic clinical programs. We expect continued growth in service lines such as cardiac, thoracic, transplant, and neurosciences. We also continue to expect continued growth in Jackson Memorial Hospital with the opening of a new emergency department. which represents an important investment in expanding access to emergency care and supporting future patient demand. Within our ambulatory network, we also continue to expect growth at the Christine Lean Rehabilitation Center, the Miami Transplant Institute, and the recently opened Jackson South Beach Express Care Clinic. These positive trends are slightly partially upset by anticipating declines in some areas, including orthopedic procedures at Jackson South, and also the competitive impact of Nicholas opening a second pediatric unit and Monsina also opening a new freestanding ED in the Westchester area. The next slide illustrates how these assumptions compare with our current year projection, which is 2026, and it also shows two additional closed fiscal years, 2024 and 2025. So we can look now how these assumptions translate into revenues. We anticipate continued growth in net patient service revenue, primarily driven by a better payer mix, especially in managed care and Medicare. also higher acuity across our health system. The volume assumptions at Jackson Memorial are also driving some of these increases as well as the continued improvements and efforts to improve cash collections, denials, reductions, and clinical documentation improvement initiatives. We also have incorporated into the budget a 5.2 million associated with managed care contract rate improvement resulting from negotiated reimbursement increases. Beyond patient revenue, we also anticipate a modest growth in our other operating revenue. This increase is primarily driven by higher provider billing collections within our Jackson Medical Group, as well as continued expansion of grant-funded programs that support several important clinical initiatives. On the other hand, our sales tax is expected to be reduced by $8.4 million, and this is reflecting current economic forecasts available during the budget development process by the county. Non-operating revenue continues to include important funding sources for Jackson, which is our graduate medical education and our indirect medical education, as well as the interest income that we have in that bucket as well. If we turn now to the expenses, our largest component of our expenses are salary, wages, and benefits. And in 2027, we have incorporated 296 additional full-time equivalents, primarily to support anticipated patient volume growth, the expansion of clinical programs, and the opening of new services. We have also incorporated, like in every other year, annual employee merit increases, the cost of leaving adjustment that was implemented in April of 2026, and anticipated increases that we have also in health insurance and retirement benefit costs. purchase services is also showing that is increasing in 2027. And this is due to higher maintenance contracts associated with new facilities and equipment increase in growth in organ acquisition costs to support our transplant program, expanded value of services agreement, higher dialysis service costs and additional marketing initiatives. Our supply expense is including a 2% inflationary increase across all our major supply categories, as well as changes in utilization associated with our projected patient volumes. Finally, depreciation and interest expense are increasing as well. Depreciation because of the addition of the new emergency department at Jackson Memorial, and interest income is increasing because of the 2020 CIS revenue bond issuance. So what you see on the screen right now is a slide that brings together our expenses and revenue. So it's a summary of our proposed operating budget, which was presented on a balanced basis with our operating expenses or our expenses being covered by our revenues. So that's why you see a zero bottom line. Total income and loss equals zero for 2027. Okay, so we can move now to capital. The proposed capital plan for 2027 is 251.5 million, and it includes projects across entire health system involving patient care areas, diagnostic equipment, information technology, facility improvement, and infrastructure upgrades. Each project has been carefully evaluated and prioritized based on a strategic importance, operational necessity, patient safety, and of course, available financial resources. There is an appendix that shows two additional schedules, and these are the schedules required by the county that we have to submit along with our budget. So this basically concludes my presentation for today. Thank you for your time and attention, and I'll be happy to take any questions you may have.

Thank you, Suzelle. Do we have any questions? Okay. Yeah, this presentation is consistent with a presentation that we had last month. No, no changes. As presented by Suzanne. Madam Chair. Yes.

I have a question. I just wanted to thank you, Giselle, and Mark, and your entire team. Overseeing a budget of this magnitude is no small thing. And I'm just super grateful to have your professionalism and responsibility in doing it. Thank you.

Thank you very much.

Suzelle, can you maybe, and I know I've asked you this in the past, but for the benefit of everyone, walk through your process and how many team members you have and how you coordinate with the different CEOs.

Sure. So the whole financial planning and analysis team, we're a total of 10. Six of them are primarily focusing on the budget. And every year we start the budget around, January, I want to say. That's when we start. There is a lot of preparation prior to that. So we have to get our systems ready. We have to talk to HR. We have to talk to the different areas to get the volume assumptions that we need to incorporate into our tool. By volume assumptions, I mean, are we going to have any managed care rate increases in our budget? Are we going to have increases in health insurance and retirement costs, all of that gets put into the system before we open the plan files for the areas to start inputting their budget. So it's about a month that areas go in and put together their budget, they submit their budget to us, then the budget goes through a significant process of review between the whole executive team. So it started with Mark and myself, and then it goes to David, and there are meetings that happen. So the budget starts with a number, and then it completes a different number. So Mark does a great job making sure that everybody keeps us on track. on a financial stable position moving forward. So we look at volume assumptions, so it gets very intensive and very labor intensive. So after all, so we put together what we call a consolidated budget, and that's what you guys are reviewing today.

How accurate are the sales tax revenue estimates from the county historically?

So what you see today in the presentation is the most updated numbers that we receive from the county at the time that we put together our budget. There are reconciliations that I understand it happens based on actuals, and then that number gets finally adjusted so that you can see a variance between our actuals and our budget.

But I'm just saying, like, historically, Mark, do we come under, over? No, there's always a pickup.

They generally pick up, so we stick with the most conservative. Right, so their revenue estimating tends to be conservative, and then there's a quarterly reconciliation based on actual cash receipts, and then we get a year-end adjustment. So right now we're up about $8 million to what you see recorded on a year-to-date basis because we wait until it's flushed out. Last year the net pickup was $18 million. So historically there's always a positive adjustment when the actual comes in.

County up kind of use conservative numbers when they issue their estimates.

Yeah, so this this happens to be unusual that we would see a decrease from current year projection to budget. But we are the one pet the half penny sale tax is the county uses that also for their transit so it's the same number that they use in their projections and we are our process is to report it to them.

But there are two half-penny sales taxes. One is ours, one is transportation. That's correct. Yeah, so it's one penny.

Yeah, correct.

And, Moj, we covered last month that there's an inflation assumption for supplies. If that inflation assumption changes by 1%, it's an additional $5 million, I recall you sharing with us.

Supplies, no? Is that where it is? Yeah.

So if that number were to increase, so there's headwinds and there's tailwinds. Right.

I think I've lived the budgeting process long enough to know that there's – you know, some fluidity and variation. And then, you know, unfortunately, sometimes unexpected things, but generally inflationary numbers are just trending up and up. So, yeah, it's just part and parcel. Thank you.

All right. Any additional comments or questions?

I'm not sure if I could just interject. I WANT TO THANK ZUZEL. SHE'S DONE AN INCREDIBLE JOB. I THINK YOU PROBABLY KNOW THAT THE LAST FEW YEARS, OUR BUDGET PROCESS HAS BEEN VERY CLEAN, MUCH MORE EFFICIENT. SHE'S IDENTIFIED A LOT OF PROCESS IMPROVEMENTS. UNFORTUNATELY, I'M SORRY TO REPORT THAT THIS WILL BE ZUZEL'S LAST BUDGET. SHE IS MOVING ON TO DIFFERENT OPPORTUNITIES. SHE HAS BEEN WITH JACKSON FOR 15-PLUS YEARS, AND I'VE KNOWN HER FOR 20 YEARS. SHE HAS CONTINUED TO DEMONSTRATE INCREASED RESPONSIBILITY AND SIGNIFICANT PERFORMANCE AND OPPORTUNITIES. SO JUST WANTED TO TAKE THE OPPORTUNITY TO THANK HER AND FOR HER EFFORTS IN THIS BUDGET.

THANK YOU. THANK YOU. YOU WILL BE MISSED.

I'LL MISS EVERYBODY AS WELL.

Okay, thank you. Thank you so much, Suzanne. And best of luck. Um, so in front of us, we have a resolution to make a recommendation to the county for the budget as presented to Chris, you want to walk us through that, please?

Sure. So yeah, you've got the only item item made a resolution approving the operating and capital budgets for the health system fiscal year 2627.

Do we have a motion?

So moved.

All those in favor?

Aye. Great. Okay.

That adjourns our meeting. Thank you so much. Have a great afternoon.