999.

5(d)(5)(C)

Description of Services to Medi-Cal, County Indigent and Other

Classes of Patients
A description of the medical services provided by Seton Medical Center to Medi-Cal patients, county
indigent patients and other classes of patients is set forth in the Community Health Impact Report,
attached to Section (5) (G) of this application, and is incorporated by reference herein. The data and/or
information provided by Seton Medical Center in response to this section represents its best estimate of
the costs of the medical services provided by Seton Medical Center to its Medi-Cal, Medicare, managed
care, county indigent and other classes of patients. Generally, all types of medically necessary hospitals
services are available to these classes of patients.
Relevant excerpts from the Community Health Impact Report are attached hereto.

Profile and Key Services: Seton Medical Center (SMC), Daly City,
CA

SMC is an acute care hospital located in Daly City, CA, with a licensed capacity of 357 beds, of
which 274 are general acute care beds and 83 are sub-acute and skilled nursing beds
Founded as Marys Help Hospital in 1893, SMC serves the people of San Francisco and San
Mateo Counties with a comprehensive range of inpatient and outpatient healthcare services
In keeping with the DCHS mission to provide quality, accessible healthcare services to the
community, SMCs St. Elizabeth Ann Seton New Life Centers program offers a comprehensive
perinatal program to low-income women
The San Francisco Heart & Vascular Institute, a Center of Excellence at SMC, has been
recognized by major insurance carriers for expertise and institutional commitment in providing
integrated cardiac care that meets high standards
Other centers of excellence include the San Francisco Spine Institute and the San Francisco
Center for Advanced Wound Care, each with clinical outcomes among the best in the nation
SMC ranked #5 in U.S. News and World Report Best Hospital San Francisco Metropolitan Area
2010-11 with three high-performing specialties: gynecology; kidney disorders; and orthopedics
and joint replacement
In FY2013, SMC and its subsidiary Seton Coastside (SMCC) together provided more than $27
million in community benefit programs and services to the community, as well as more than $47
million in care for the elderly

Key services at Seton Medical Center include:

Cardiovascular Services
Cancer Care / Oncology
Diabetes Services
Emergency Services
Imaging & Laboratory Services

Orthopedics and Joint Replacement

Palliative Care
Rehabilitation Services
Spine Care
Spiritual Care
Stroke Care
Surgical Services
Womens Health
Wound Care

Profile and Key Services: Seton Medical Center Coastside (SMCC),

Moss Beach, CA

SMCC is an accredited rural hospital providing emergency services, skilled nursing care and
outpatient ancillary services
SMCC is a subsidiary of SMC and operates under its license. SMCC receives administrative,
information technology and other ancillary support services from SMC.
The facility has a licensed capacity of 121 beds, of which five are acute/emergency department
beds and 116 are skilled nursing beds
SMCC and its predecessors have been providing services in the area since 1970
SMCC operates a 24-hour standby emergency department, the only such facility on the Pacific
Coast from Daly City to Santa Cruz
SMCC offers several inpatient and outpatient programs, including, spiritual care, community
outreach and emergency services

Key services at Seton Coastside include:

Skilled Nursing
Coastside Community Outreach Programs
Emergency Services
Physical, occupational and speech therapy
Radiology/mammography
Laboratory
RotaCare Clinic
Spiritual Care Services

Cost and Revenue by Payor (SMC and SMCC)

SMC and SMCC rely on government programs for reimbursement of services with Medicare
and Medi-Cal participants

Medicare and Medi-Cal accounted for approximately 55% and 16% of patient days at SMC
in FY2012, and approximately 55% and 15% in FY2013, respectively
SMCC relies heavily on Medi-Cal for its occupancy
o Medi-Cal participants accounted for approximately 50% of all patient days over the
past two years
The skilled nursing facility at SMCC had a payor mix of approximately 89% in January, 2014
o SMCC is one of only a few standalone SNFs in the region that accepts Medi-Cal
In 2014, the ALOS for Medi-Cal patients was more than 5x longer than any other payor
On July 23, 2013, the San Mateo County Supervisors approved the initial allocation of
Measure A funding of $12 million to SMC (nine-month period between October 2013 and
June 2014)
o $2 million was allocated for seismic compliance work
o $500,000 has been dedicated to fund a strategic plan for the hospitals to be conducted
in collaboration with the County by February 2014
o As originally contemplated, a long-term allocation of Measure A funding would
amount to approximately $135 million, or $15 million per annum, over the next nine
years
Seton Medical Center
Cost of Services by Payer Category
FY 2010 - 2014
2010

2011

2012

2013

2014

Operating Expenses
Adjusted Operating Expenses

$297,374,146 $310,145,213 $286,950,046 $298,967,395 $282,932,167

$289,373,153 $287,236,915 $264,555,692 $273,955,577 $271,451,513

Cost of Services by Payer

Medicare
Medi-Cal
Third Party
Other

$145,842,321 $146,808,283 $130,720,920 $137,587,002 $136,719,992

$67,504,648 $64,164,249 $62,617,542 $65,038,694 $62,026,020
$67,011,014 $69,653,910 $62,269,338 $65,770,664 $66,386,884
$9,015,170
$6,610,472
$8,947,892
$5,559,217
$6,318,617

Seton Medical Center

Net Patient Revenue by Payer
FY 2010 - 2014
2010
Medicare
Medi-Cal
Third Party
Other

2012

2013

2014

$108,266,550 $104,676,034 $96,709,412 $102,570,971 $94,562,126

$38,434,614 $48,826,265 $48,808,462 $59,389,612 $38,424,288
$131,833,711 $132,675,194 $112,187,230 $109,606,300 $114,035,900
($2,563,413)
$113,360
$354,860
($5,539,291) ($4,422,721)
Total

$275,971,462 $286,290,853 $258,059,964 $266,027,592 $242,599,593

Source: OSHPD Disclosure Reports 2010 - 2014

Patient Origin

2011

Seton Medical Center Actual

YTD FY11
Jul-Jun

YTD FY12
Jul-Jun

YTD FY13
Jul-Jun

YTD FY14
Jul-Jun

YTD FY15
Jul-May

PATIENT REVENUE
Inpatient Gross Revenue
Inpatient Medicare
Inpatient Medi-Cal
Inpatient HMO/PPO
Inpatient Self-Pay

$
$
$
$

410,230,531
236,415,527
355,675,592
24,503,178

$
$
$
$

372,617,758
228,899,843
354,920,745
8,453,946

$
$
$
$

368,914,638
205,395,429
343,342,510
25,548,021

$
$
$
$

364,290,515
232,444,322
357,108,027
25,135,386

$
$
$
$

299,140,660
219,343,330
309,873,320
13,554,837

4,123,052

3,377,271

8,069,769

8,100,599

9,371,534

$
$
$
$
$
$
$

154,636,215
66,286,340
232,730,309
26,746,284
1,741,700
1,513,088,728

$
$
$
$
$
$
$

152,814,983
72,564,212
228,137,018
21,392,474
2,152,318
1,445,330,568

$
$
$
$
$
$
$

149,525,753
70,869,917
233,330,354
16,724,889
1,536,574
1,423,257,854

$
$
$
$
$
$
$

164,066,337
85,787,994
235,827,982
16,523,964
2,442,124
1,491,727,250

$
129,339,888
$
97,191,171
$
206,646,171
$
10,527,625
$
$
2,060,602
$ 1,297,049,138

Inpatient Capitation
Inpatient Other
Outpatient Gross Revenue
Outpatient Medicare
Outpatient Medi-Cal
Outpatient HMO/PPO
Outpatient Self-Pay
Outpatient Capitation
Outpatient Other
TOTAL PATIENT REVENUES
Days
Total Medicare Days
Total Medi-Cal Days
Total HMO/PPO Days
Total Self-Pay Days
Total Capitation Days
Total Other Days
TOTAL DAYS

21,393
19,692
17,907
1,147
60,139

17,789
17,514
15,306
441
51,050

16,197
15,891
14,156
1,238
47,482

15,466
16,756
13,581
1,003
46,806

12,938
16,205
13,191
532
42,866

2,968
1,363
3,208
176
7,715

2,619
1,333
2,977
80
7,009

2,794
1,197
2,913
221
7,125

2,532
1,204
2,824
195
6,755

2,130
1,138
2,589
89
5,946

Discharges
Medicare Discharges
Medi-Cal Discharges
HMO/PPO Discharges
Self-Pay Discharges
Capitation Discharges
Other Discharges
TOTAL DISCHARGES

Seton Medical Center Coastside

Actual
YTD FY11
Jul-Jun

YTD FY12
Jul-Jun

YTD FY13
Jul-Jun

YTD FY14
Jul-Jun

YTD FY15
Jul-May

PATIENT REVENUE
Inpatient Gross Revenue
Inpatient Medicare
Inpatient Medi-Cal
Inpatient HMO/PPO
Inpatient Self-Pay
Inpatient Capitation
Inpatient Other

$
$
$
$
$
$

391,124
28,085,111
1,134,622
103,805
-

$
$
$
$
$
$

3,244,025
35,998,433
2,844,636
474,639
10,387

$
$
$
$
$
$

3,692,770
45,480,005
2,381,168
1,207,717
61,439

$
$
$
$
$
$

2,190,155
48,774,817
1,567,458
2,085,463
-

$
$
$
$
$
$

1,541,485
44,711,723
2,213,770
92,874
-

$
$
$
$
$
$
$

2,440,222
2,105,460
5,591,848
1,211,948
382,852
41,446,991

$
$
$
$
$
$
$

2,737,961
2,336,130
5,247,413
1,028,269
421,529
54,343,421

$
$
$
$
$
$
$

2,485,029
1,941,852
4,781,751
1,061,597
357,406
63,450,728

$
$
$
$
$
$
$

2,089,922
2,831,196
5,025,061
1,236,639
354,657
66,155,368

$
$
$
$
$
$
$

2,091,538
4,077,690
4,520,188
1,100,087
322,840
60,672,195

Outpatient Gross Revenue

Outpatient Medicare
Outpatient Medi-Cal
Outpatient HMO/PPO
Outpatient Self-Pay
Outpatient Capitation
Outpatient Other
TOTAL PATIENT REVENUES
Days
Total Medicare Days
Total Medi-Cal Days
Total HMO/PPO Days
Total Self-Pay Days
Total Capitation Days
Total Other Days
TOTAL DAYS

238
32,050
1,054
201
33,543

1,402
33,025
1,513
333
36,273

1,770
35,087
1,412
513
38,782

1,097
34,605
696
984
37,382

629
31,621
857
370
33,477

2
35
10
2

15
71
18
4

23
56
11
11

20
46
16
4

7
44
12
1

49

108

101

Discharges
Medicare Discharges
Medi-Cal Discharges
HMO/PPO Discharges
Self-Pay Discharges
Capitation Discharges
Other Discharges
TOTAL DISCHARGES

86

64

The table below demonstrates that 20 zip codes comprise the service area from which 85.9% of St.
Francis Medical Centers inpatient discharges originated in CY 2011. The top three zip codes account for
52.2% of total discharges.

ZIP Code

Community

Service
Seton
Percent Cumulative Area Total
Discharges of Total
Percent Discharges

Daly City
Daly City
94080
South San Francisco
94044
Pacifica
94112
San Francisco
94066
San Bruno
94134
San Francisco
94132
San Francisco
94116
San Francisco
94019
Half Moon Bay
94110
San Francisco
94124
San Francisco
94030
Millbrae
94127
San Francisco
94010
Burlingame
94103
San Francisco
94002
Belmont
94083
South San Francisco
94011
Burlingame
94016
Daly City
Subtotal

1,733
1,116
998
752
453
414
184
162
93
88
77
76
51
50
41
20
11
6
3
3
6,331

23.5%
15.1%
13.5%
10.2%
6.1%
5.6%
2.5%
2.2%
1.3%
1.2%
1.0%
1.0%
0.7%
0.7%
0.6%
0.3%
0.1%
0.1%
0.0%
0.0%
85.9%

23.5%
38.7%
52.2%
62.4%
68.6%
74.2%
76.7%
78.9%
80.2%
81.3%
82.4%
83.4%
84.1%
84.8%
85.4%
85.6%
85.8%
85.9%
85.9%
85.9%

All Other

1,036

14.1%

100.0%

Total

7,367

100.0%

94015
94014

Source: OSHPD 2011 Inpatient Database

Note: Excludes normal newborns

4,624
3,361
5,330
2,874
6,908
3,501
3,743
1,999
4,345
1,173
6,300
4,185
1,951
1,615
3,162
3,549
1,988
33
35
14

Seton
Market
Share
37.5%
33.2%
18.7%
26.2%
6.6%
11.8%
4.9%
8.1%
2.1%
7.5%
1.2%
1.8%
2.6%
3.1%
1.3%
0.6%
0.6%
18.2%
8.6%
21.4%

Seton Medical Center Hospital Service Area Map

Daughters of Charity Health System

Seton Medical Center
Primary Service Area
Secondary Service Area

Area Hospitals
1.
2.
3.
4.

CA Pacific Med. Ctr. St. Lukes

Kaiser Hospital South San. Fran.
Peninsula Med. Ctr.
San. Fran. General Hosp. Med. Ctr.

Service Area Population and Demographic Profile

The total population in Seton Medical Centers service area is expected to growth at a rate of 1.0%
annually through CY 2019, with the fastest growth occurring in the 65+ age cohort.

Age Cohort
Service Area
0-17
18-44
45-64
65+
Total

California
0-17
18-44
45-64
65+
Total

Estimated 2014
Percent
of Total
Population

Projected 2019
Percent
of Total
Population

CAGR

Cumulative
Change 20142019

137,305
278,423
206,739
108,489
730,956

18.8%
38.1%
28.3%
14.8%
100.0%

143,454
275,902
217,838
132,866
770,060

18.6%
35.8%
28.3%
17.3%
100.0%

0.9%
-0.2%
1.1%
4.1%
1.0%

4.5%
-0.9%
5.4%
22.5%
5.3%

9,313,067
14,639,527
9,786,617
4,810,836
38,550,047

24.2%
38.0%
25.4%
12.5%
100.0%

9,388,558
14,892,503
10,244,346
5,734,627
40,260,034

23.3%
37.0%
25.4%
14.2%
100.0%

0.2%
0.3%
0.9%
3.6%
0.9%

0.8%
1.7%
4.7%
19.2%
4.4%

Source: Claritas 2014 Database

The service area households are more affluent compared to the state of California overall, with a median
household income of $76,734 compared to the state median of $54,015.

Socioeconomic Indicator

Estimated 2014 Projected 2019

CAGR

Cumulative
Change
2014-2019

Service Area
Population

730,956

770,060

1.0%

5.3%

Households

252,909

267,313

1.1%

5.7%

2.8

2.8

0.0%

-0.1%

Median Household Income

$76,734

$85,869

2.3%

11.9%

Average Household Income

$108,184

$119,584

2.0%

10.5%

15.6%
17.4%
28.5%
38.5%

14.0%
16.0%
27.2%
42.8%

-1.0%
-0.5%
0.1%
3.3%

-5.1%
-2.6%
0.6%
17.6%

38,550,047

40,260,034

0.9%

4.4%

13,003,529

13,592,743

0.9%

4.5%

2.9

2.9

0.0%

0.0%

Median Household Income

$54,015

$56,929

1.1%

5.4%

Average Household Income

$81,689

$87,810

1.5%

7.5%

21.9%
22.3%
29.2%
26.6%

20.5%
21.4%
28.6%
29.5%

-0.5%
0.1%
0.5%
3.0%

-2.4%
0.6%
2.4%
15.8%

Average Household Size

Income Distribution
Under $25,000
$25,000-$49,999
$50,000-$99,999
$100,000 +

California
Population
Households
Average Household Size

Income Distribution
Under $25,000
$25,000-$49,999
$50,000-$99,999
$100,000 +