Effect of the Ministry Alignment Agreement
between Dignity Health and Catholic Health
Initiatives on the Availability and Accessibility of
Healthcare Services to the Communities Served by
Dignity Health’s Hospitals Located in Sacramento
County
Prepared for the Office of the California Attorney General
August 13, 2018

© 2018 Vizient, Inc. and JD Healthcare. All rights reserved.

 Table of Contents
Introduction & Purpose .................................................................................................................. 5
Introduction ............................................................................................................................... 5
Purpose ...................................................................................................................................... 7
Background & Description of the Transaction ................................................................................ 8
Background ................................................................................................................................ 8
Strategic Rationale, Transaction Process & Timing ................................................................... 8
Summary of the Ministry Alignment Agreement..................................................................... 11
System Corporation Post the Effective Date of the Ministry Alignment Agreement .............. 12
System Corporation Post Debt Consolidation (Within 36 Months) ......................................... 13
Major Provisions of the Ministry Alignment Agreement.............................................................. 13
Structures and Responsibilities ................................................................................................ 14
Dignity Health Commitments ................................................................................................... 19
Use of Net Sale Proceeds ......................................................................................................... 22
Profile of Catholic Health Initiatives ............................................................................................. 23
Overview .................................................................................................................................. 23
Key Statistics............................................................................................................................. 23
Payer Mix.................................................................................................................................. 24
Financial Profile ........................................................................................................................ 25
Profile of Dignity Health ................................................................................................................ 26
Payer Mix.................................................................................................................................. 27
Financial Profile ........................................................................................................................ 28
Dignity Health’s California Hospitals Overview ....................................................................... 29
Analysis of Dignity Health’s Sacramento County Hospital Market Share..................................... 30
Profile of Methodist Hospital of Sacramento ............................................................................... 32
Overview .................................................................................................................................. 32
Key Statistics............................................................................................................................. 33
Patient Utilization Trends......................................................................................................... 34
Financial Profile ........................................................................................................................ 35
Cost of Hospital Services .......................................................................................................... 36
Charity Care .............................................................................................................................. 36
Community Benefit Services .................................................................................................... 38
Reproductive Health ................................................................................................................ 43
Analysis of Methodist Hospital of Sacramento ............................................................................ 44
Service Area Definition............................................................................................................. 44
Service Area Map ..................................................................................................................... 45
2

 Hospital Market Share ............................................................................................................. 46
Market Share by Payer Type .................................................................................................... 47
Market Share by Service Line ................................................................................................... 48
Market Share by ZIP Code ........................................................................................................ 49
Profile of Mercy San Juan Medical Center .................................................................................... 50
Overview .................................................................................................................................. 50
Key Statistics............................................................................................................................. 51
Patient Utilization Trends......................................................................................................... 52
Financial Profile ........................................................................................................................ 53
Cost of Hospital Services .......................................................................................................... 54
Charity Care .............................................................................................................................. 54
Community Benefit Services .................................................................................................... 56
Reproductive Health ................................................................................................................ 60
Analysis of Mercy San Juan Medical Center ................................................................................. 62
Service Area Definition............................................................................................................. 62
Service Area Map ..................................................................................................................... 63
Hospital Market Share ............................................................................................................. 64
Market Share by Payer Types .................................................................................................. 65
Market Share by Service Line ................................................................................................... 66
Market Share by ZIP Code ........................................................................................................ 67
Profile of Mercy Hospital of Folsom ............................................................................................. 68
Overview .................................................................................................................................. 68
Key Statistics............................................................................................................................. 69
Patient Utilization Trends......................................................................................................... 70
Financial Profile ........................................................................................................................ 71
Cost of Hospital Services .......................................................................................................... 72
Charity Care .............................................................................................................................. 72
Community Benefit Services .................................................................................................... 74
Reproductive Health ................................................................................................................ 77
Analysis of Mercy Hospital of Folsom ........................................................................................... 78
Service Area Definition............................................................................................................. 78
Service Area Map ..................................................................................................................... 79
Hospital Market Share ............................................................................................................. 80
Market Share by Payer Type .................................................................................................... 81
Market Share by Service Line ................................................................................................... 82
Market Share by ZIP Code ........................................................................................................ 84
Profile of Mercy General Hospital ................................................................................................ 85
Overview .................................................................................................................................. 85
3

 Key Statistics............................................................................................................................. 86
Patient Utilization Trends......................................................................................................... 87
Financial Profile ........................................................................................................................ 88
Cost of Hospital Services .......................................................................................................... 89
Charity Care .............................................................................................................................. 89
Community Benefit Services .................................................................................................... 91
Reproductive Health ................................................................................................................ 95
Analysis of Mercy General Hospital’s Service Area ...................................................................... 97
Service Area Definition............................................................................................................. 97
Service Area Map ..................................................................................................................... 98
Hospital Market Share ............................................................................................................. 99
Market Share by Payer Type .................................................................................................. 100
Market Share by Service Line ................................................................................................. 101
Market Share by ZIP Code ...................................................................................................... 102
Assessment of Potential Issues Associated with the Availability or Accessibility of Healthcare
Services ....................................................................................................................................... 104
Continuation as General Acute Care Hospitals ...................................................................... 104
Emergency Services................................................................................................................ 106
Reproductive Health Services ................................................................................................ 108
Effects on the Level & Type of Charity Care Historically Provided ........................................ 109
Effects on Services to Medi-Cal, Medicare & Other Classes of Patients ............................... 109
Effects on Community Benefit Programs ............................................................................... 111
Effects on Hospital Licensed Services .................................................................................... 112
Effects on Programs and Services .......................................................................................... 113
Effects on Staffing & Employee Rights ................................................................................... 115
Effects on Medical Staff ......................................................................................................... 116
Effects on City and County Contracts .................................................................................... 116
Alternatives ............................................................................................................................ 116
Conclusions and Recommendations ........................................................................................... 117
Methodist Hospital of Sacramento License ........................................................................... 129
Mercy San Juan Medical Center License ................................................................................ 130
Mercy Hospital of Folsom License ......................................................................................... 131
Mercy General Hospital License............................................................................................. 132

4

 Introduction & Purpose
JD Healthcare, Inc. and Vizient, Inc. were retained by the Office of the California Attorney
General to prepare this healthcare impact statement to assess the potential impact of the
proposed Ministry Alignment Agreement by and between Dignity Health, a California nonprofit
public benefit corporation, and Catholic Health Initiatives, a Colorado nonprofit corporation
(CHI), on the availability and accessibility of healthcare services to the communities served in
Sacramento County. Dignity Health owns and operates 31 general acute care hospitals in
California, including four in Sacramento County: Methodist Hospital, located in Sacramento,
Mercy San Juan Medical Center, located in Carmichael, Mercy Hospital of Folsom, located in
Folsom, and Mercy General Hospital, located in Sacramento.
CHI is the parent organization of several nonprofit corporations that own and/or operate over
100 hospitals in 18 states. CHI neither owns, nor controls any general acute care hospitals or
other facilities in California. CHI is a Catholic organization.
Introduction
Catholic Health Care Federation (CHCF) is a public juridic person1 within the meaning of Canon
Law and the canonical sponsor2 of CHI.
While Dignity Health is not a Catholic organization, its Catholic hospitals are sponsored by six
congregations of Women Religious3. Dignity Health owns and operates 31 general acute care
hospitals in California4. Nineteen of the 31 California hospitals are Catholic and 12 are nonCatholic hospitals (also referred to as community hospitals). Four of the 12 non-Catholic general
acute care hospitals are owned by separately incorporated California nonprofit public benefit
corporations that have Dignity Health as their sole corporate member5. Dignity Health also
owns and operates five hospitals in Arizona and three hospitals in Nevada.
The following summary chart is a list of Dignity Health owned and operated hospitals 6.

1

A public juridic person is a group or persons approved by the Roman Catholic Church to oversee and ensure that the mission of its healthcare
organization is carried out according to Catholic principles.
2 The Catholic Health Association has defined canonical sponsorship of a healthcare ministry as a formal relationship between an authorized
Catholic organization and a legally formed system, hospital, clinic, nursing home (or other institution) entered into for the sake of promoting
and sustaining Christ's healing ministry to people in need.
3 A group of Roman Catholic women who dedicate their lives to the Gospel of Jesus Christ and take vows of poverty, chastity, obedience and
service. The six congregations are: Sisters of Mercy of the Americas, Sister of Charity of the Incarnate Word, Dominican Sisters of San Rafael,
Sisters of St. Francis of Penance and Christian Charity, Adrian Dominican Sisters and the Congregation of Sisters of St. Dominic of St. Catherine
of Siena. Dignity Health’s sponsorship council is comprised of one sister from each congregation.
4 The California Department of Public Health has issued twenty-eight general acute care hospital licenses with respect to these 31 facilities.
Marian Regional Medical Center, Arroyo Grande Campus operates under a consolidated license issued to Marian Regional Medical Center, and
Mercy Southwest Hospital operates under a consolidated license issued to Mercy Hospital (in Bakersfield).
5 The four facilities are Bakersfield Memorial Hospital, Community Hospital of San Bernardino, Saint Francis Memorial Hospital, and Sierra
Nevada Memorial-Miners Hospital.
6 St. Joseph Medical Center of Stockton and St. Joseph Behavioral Health Center are owned by Port City Operating Company, LLC, a joint
venture between Kaiser Foundation Hospitals and Dignity Health. Dignity Health owns 80% of Port City Operating Company, LLC, and Kaiser
Foundation Hospitals owns the remaining 20%.

5

 Dignity Health
Arizona
Hospitals
 Arizona General Hospital1*
 Chandler Regional Medical Center*
 Mercy Gilbert Medical Center
 St. Joseph’s Hospital and Medical
Center
 St. Joseph’s Westgate Medical
Center

California Hospitals
Dignity Health Owned
Hospitals
 Dominican Hospital
 Marian Regional Medical Center
 Marian Regional Medical Center,
Arroyo Grande Campus*
 Marian Regional Medical Center
West
 Mercy General Hospital
 Mercy Hospital of Folsom
 Mercy Medical Center Merced
 Mercy Medical Center Mt. Shasta
 Mercy Medical Center Redding
 Mercy San Juan Medical Center
 Mercy Hospital
 Mercy Southwest Hospital
 St. Bernardine Medical Center
 St. Elizabeth Community Medical
Center
 St. John’s Pleasant Valley Medical
Center
 St. John’s Regional Medical Center
 St. Joseph’s Medical Center of
Stockton
 St. Joseph’s Behavioral Health
Center
 St. Mary Medical Center
 St. Mary’s Medical Center
 California Hospital Medical Center*
 French Hospital Medical Center*
 Glendale Memorial Hospital*
 Methodist Hospital of Sacramento*
 Northridge Hospital Medical Center*
 Sequoia Hospital*
 Woodland Memorial Hospital*

Subsidiary Hospitals
 Bakersfield Memorial Hospital*
 Community Hospital of San Bernardino*
 Saint Francis Memorial Hospital*
 Sierra Nevada Memorial- Miners Hospital*

Nevada
Hospitals
 St. Rose Dominican, Rose de Lima Campus
 St. Rose Dominican, San Martin Campus
 St. Rose Dominican, Siena Campus

*Denotes non-Catholic hospitals.
All other hospitals are ministries
of the Catholic Church
1Arizona

General Hospital is
owned by a separate limited
liability company of which
Dignity Health is the sole
corporate member

In addition to the hospitals listed above, Dignity Health has a management agreement with
Mark Twain Medical Center Corporation, a California nonprofit public benefit corporation, to
operate Mark Twain Medical Center, a 25-bed critical access hospital7 located at 768 Mountain
Ranch Road, San Andreas, California. Mark Twain Medical Center is leased by Mark Twain
Medical Center Corporation from the Mark Twain Healthcare District. The current lease
agreement with Mark Twain Healthcare District expires on December 31, 2019. On June 6,
2018, the voters in the Healthcare District approved Ballot Measure A to enter into a new 30year lease for Mark Twain Medical Center.

7

A critical access hospital is a designation given to eligible rural hospitals, or those grandfathered as rural, by the Centers for Medicare and
Medicaid Services. Conditions to obtain a Critical Access Hospital designation include having less than or equal to 25 acute care beds, being
located more than 35 miles from another hospital, maintaining an annual average length of stay of 96 hours or less for acute care patients and
providing 24- hour emergency care services.

6

 Purpose
This healthcare impact statement describes the potential effects that the proposed transaction
may have on the availability and accessibility of healthcare services to the residents served by
Methodist Hospital of Sacramento, Mercy San Juan Medical Center and Mercy Hospital of
Folsom and Mercy General Hospital.
In preparation of this report, JD Healthcare, Inc. and Vizient, Inc. performed the following:
● A review of the written notice delivered to the California Attorney General on March 29,
2018 and supplemental information subsequently provided by Dignity Health;
● A review of press releases and articles related to this and other hospital transactions;
● Interviews with representatives of Dignity Health;
● An analysis of financial, utilization, and service information provided by Dignity Health
and the California Office of Statewide Health Planning and Development (OSHPD); and
● An analysis of publicly available data related to service areas for Methodist Hospital of
Sacramento, Mercy San Juan Medical Center and Mercy Hospital of Folsom and Mercy
General Hospital including hospital utilization rates and trends and hospital inpatient
market share.

7

 Background & Description of the Transaction
Background
Dignity Health was formerly known as Catholic Healthcare West. Catholic Healthcare West was
founded in 1986 when the Sisters of Mercy Burlingame Regional Community and the Sisters of
Mercy Auburn Regional Community merged their healthcare ministries. In 2009, the United
States Conference of Catholic Bishops changed the Ethical and Religious Directives8 (ERDs)
regarding partnerships between community and Catholic organizations. As a result of the
changes to the ERDs, Catholic Healthcare West went through a process, between 2009 and
2011, to review its governance structure and its relationship to its owned and controlled nonCatholic community hospitals. In 2012, as a result of this review and based on discussions with
its canonical sponsors, Catholic Healthcare West reorganized its governance structure and
changed its name to Dignity Health. Dignity Health was no longer recognized as a Catholic
organization, although many of its hospitals are Catholic. The restructure was designed to
satisfy the requirements of the United States Conference of Catholic Bishops regarding
partnerships with non-Catholic community hospitals while allowing Dignity Health to maintain
its Catholic and non-Catholic hospitals under a single organization.
Following the 2012 reorganization, the six congregations of Women Religious began the
exploration of alternatives models for sponsorship of Dignity Health’s Catholic hospitals,
including the possibility for Dignity Health being recognized as a Catholic ministry. To facilitate
this process, the Sponsors engaged a canon lawyer9 to help explore all of the options, such as
the creation of a new public juridic person or a merger with a Catholic healthcare system
sponsored by an existing public juridic person. As further described below, the alignment
discussions between Dignity Health and CHI revealed many significant potential strategic
benefits for both organizations, including CHI’s current sponsorship by a public juridic person
known as Catholic Health Care Federation.
Strategic Rationale, Transaction Process & Timing
The leadership of Dignity Health and CHI had numerous partnership discussions over the
previous ten years. In 2013, they explored potential affiliations between the two health
systems. Dignity Health and CHI identified several opportunities to collaborate on programs and
services, including telehealth, micro-hospitals, and precision medicine10. In September 2016,
they formed a joint-venture named the Precision Medicine Alliance, LLC to create a large
precision medicine program.

8

The Ethical and Religious Directives for Catholic Healthcare Services is a national code that guides Catholic healthcare providers on
conformance with Christian theology.
9
A canon lawyer is a lawyer who is knowledgeable of the ordinances and regulations made by ecclesiastical authority.
10 Precision medicine is an emerging approach for disease treatment and prevention that uses extensive databases and takes into account
individual variability in genes, environment, and lifestyle for each person.

8

 In the spring of 2016, the executive leadership of Dignity Health and CHI began jointly exploring
the potential for an alignment of their ministries. In March 2016, an outside advisor prepared a
white paper11 that analyzed the potential for an affiliation between Dignity Health and CHI that
was shared with the boards of directors of Dignity Health and CHI in June 2016. The boards of
directors of Dignity Health and CHI concluded that they:
● Share a vision of transformation for themselves and for the industry;
● Have highly complementary organizational missions, visions, and values;
● Serve complementary communities;
● Share strategic objectives in areas such as population health, quality, consumer focus,
growth, and others; and
● Have multiple key complementary strengths – for example, CHI’s clinical excellence and
Dignity Health’s operating model.
As a result, the boards of directors of Dignity Health and CHI requested that a business analysis
for the aligned ministry be developed. That analysis identified the following potential synergies
of aligned ministries:
● Enhancing clinical excellence;
● Improving patient experience;
● Ensuring care for the vulnerable and underserved;
● Developing talent and creating a learning organization;
● Improving access to care;
● Accelerating innovation and research; and
● Expanding the capabilities that support the health system of the future.
In addition, the white paper identified high level economic implications and synergies of an
alignment that have the potential to:
● Provide the financial resources and complementary strengths to support the capabilities
needed for a changing health system;

11

The white paper is entitled “Creating a Transformative Ministry in Response to the Signs of the Times, Cultural, Strategic, Business and
Financial Planning for an Aligned Ministry.”

9

 ● Extend the mission of social justice through a national platform for care that is
accessible and equitable to all people, with particular attention to the vulnerable and
underserved; and
● Develop new models for integrated, community focused care that combine clinical
excellence, health improvement and innovation.
On October 24, 2016, the boards of directors of Dignity Health and CHI announced the signing
of a non-binding letter of intent to explore aligning the organizations. After the signing of the
letter of intent, independent advisors from Kaufman Hall Associates, PricewaterhouseCoopers,
McKinsey & Company, and Dentons US LLP provided analyses regarding the strategic, cultural,
financial, legal, operational, and structural aspects of the alignment of the organizations. A
steering committee, comprised of executives from both organizations, was formed to negotiate
the terms of the Ministry Alignment Agreement. In March 2017, Dignity Health and CHI sought
a moral analysis12 from several Catholic theologians for the purposes of obtaining a nihil
obstat13 from Archbishop Aquila of the Denver Archdiocese and Archbishop Cordileone of the
San Francisco Archdiocese. On April 20, 2017, the boards of directors of Dignity Health passed a
resolution authorizing and approving the execution of the Ministry Alignment Agreement
subject to the moral analysis. The resolution cited the intention to combine Dignity Health and
CHI into a new nationwide health system that would:
● Serve as an unprecedented platform to further Catholic identity and the Catholic health
ministry;
● Provide an opportunity for Dignity Health and CHI’s employees, physicians, partners and
people in the communities served by Dignity Health and CHI to experience and
participate in the enhanced Catholic health ministry;
● Enhance and expand access to care and the healthcare services performed for the poor
and underserved;
● Possess a strong voice for social justice and promote advocacy at local, state and
national levels;
● Be a leader in healthcare’s transformation;
● Promote clinical efficiency and effectiveness in the delivery of healthcare and medical
services;

12

A formal report by a Catholic theologian on the appropriate application of Catholic moral teachings.
Roman Catholic Church certification by an official censor that something is not objectionable on doctrinal or moral grounds.

13A

10

 ● Provide a platform to accomplish other goals, objectives, and benefits for the
communities served by the CHI and Dignity Health;
The nihil obstats were received in October 2017. The Ministry Alignment Agreement was signed
by Dignity Health and CHI on December 6, 2017. On March 29, 2018, Dignity Health submitted
the written notice to the California Attorney General’s Office and requested the California
Attorney General’s consent to the Ministry Alignment Agreement.
Summary of the Ministry Alignment Agreement
The Ministry Alignment Agreement will be implemented primarily through the reorganization
and renaming of CHI’s current corporation. This reorganized entity will become the parent
organization (henceforth referred to as "System Corporation") over the new health system and
will be renamed before the Closing Date14 of the transaction. The governing board of the
System Corporation will initially be comprised of six directors each from the legacy boards of
directors of Dignity Health and CHI, and the Chief Executive Officers from each organization
(i.e., a total of 14 directors).
As part of the transaction, Dignity Health formed a separate Colorado nonprofit corporation
named Integrated Healthcare Operations (IHO). As of the Effective Date15 of the transaction,
Dignity Health will transfer the assets of its eight non-Catholic owned hospitals (seven of which
are in California and one in Arizona) to IHO. IHO will also become the sole corporate member
of Dignity Health’s four subsidiary hospitals in California for a total of 12 hospitals. The System
Corporation is not a member of IHO. However, the System Corporation approves the majority
of the IHO board from nominees selected by the IHO board and holds reserve powers over
certain actions to be taken by IHO. IHO will not be Catholic, and the eleven California nonCatholic hospitals16 transferred to IHO from Dignity Health and one Arizona non-Catholic
hospital will remain non-Catholic and not subject to the ERDs. The 12 non-Catholic Dignity
Health hospitals are not obligated to alter, restrict, or terminate any clinical medical service or
program that was permitted on the effective date of the transaction by reason of Catholic
doctrine or theology or any amendments to the Statement of Common Values17 or Designated
Procedures18 that increases or expands prohibited services. The 12 non-Catholic Dignity Health
hospitals will be provided with the same benefits, systems, services, and programs, and on the

14

The Closing Date is the date the parties exchange all signed documents pursuant to the conditions precedent set forth in the Ministry
Alignment Agreement. One of those conditions precedent requires the Attorney General’s consent.
15 As of 12:00:01am on the day immediately after the “Closing Date”.
16 Marian Regional Medical Center, Arroyo Grande Campus is and will remain a non-Catholic general acute care hospital. It operates under a
consolidated license issued to a Catholic general acute care hospital, Marian Regional Medical Center. Marian Regional Medical Center, Arroyo
Grande Campus will not be transferred to IHO.
17 Dignity Health’s Statement of Common Values prohibits direct abortions, in-vitro fertilizations, and provider or physician-assisted suicide or
aid in dying. The most common medical procedure performed in hospitals that is prohibited by the ERDs is tubal ligation (a surgical procedure
for female sterilization that involves severing and tying the fallopian tubes). Tubal ligations are not prohibited by Dignity Health’s Statement of
Common Values.
18
Designated Procedures means “direct sterilizations” that consist of an elective procedure, the primary purpose of which is to render the
patient permanently incapable of reproducing; provided, however, that procedures that induce sterility do not constitute a “Designated
Procedure” when their effect is the cure or alleviation of a present and serious pathology, and a simpler treatment is not available.

11

 same terms as all other hospitals in System Corporation. The 12 non-Catholic Dignity Health
hospitals will retain or adopt Dignity Health’s Statement of Common Values.
On the Effective Date, the System Corporation will become the sole corporate member of
Dignity Health and the board of directors of Dignity Health will be comprised of the same
persons who comprise the board of directors of the System Corporation. On the Closing Date,
Catholic Healthcare Federation becomes the sponsor of all Catholic activities, including Dignity
Health’s Catholic hospitals. The board members of System Corporation and Dignity Health will
be identical. A single executive management team will manage the System Corporation, Dignity
Health, and CHI Regional and Subsidiary Corporations19.
System Corporation Post the Effective Date of the Ministry Alignment Agreement
The following chart shows the organization of System Corporation after the Closing Date of the
Ministry Alignment Agreement. System Corporation would be the sole member of Dignity
Health and the CHI Regional and Subsidiary Corporations20. System Corporation would not be a
member of IHO, however, a majority of the nominees to IHO’s board of directors will be subject
to approval by System Corporation and IHO’s hospitals will retain or adopt Dignity Health’s
Statement of Common Values.

Catholic Healthcare Federation
(Canonical Sponsor)

System Corporation (CHI)

CHI Regional and
Subsidiary Corps

19 CA Catholic Hospitals
& Arroyo Grande

19

7 CA Community
Hospitals + AZ
Community
Hospital

Dignity Health

Subsidiaries

Oversight
Committees
(Designated
Procedures)

Integrated Healthcare
Operations (IHO)

Joint
Ventures

Other
Subsidiaries

Joint
Ventures

4 CA Hospital
Subsidiaries

Both Dignity Health’s and IHO’s local hospital community boards associated with each owned hospital, as well as the boards associated with
the four subsidiary hospitals, will continue to exist.
20The majority of CHI hospitals are organized into eight regional corporations.

12

 System Corporation Post Debt Consolidation (Within 36 Months)
After the Closing Date and after the restructuring and consolidation of the existing tax-exempt
bonds and other debt of CHI and Dignity Health, Dignity Health and the CHI Regional and
Subsidiary Corporations will merge into System Corporation, and the four non-Catholic
separately-incorporated hospitals will merge into IHO.

Catholic Healthcare Federation
(Canonical Sponsor)

Integrated Healthcare
Operations (IHO)

CHI Regional and
Subsidiary Corps

19 CA Catholic
Hospitals & Arroyo
Grande

13

Oversight
Committees
(Designated
Procedures)

Merger

Merger

System Corporation (CHI)

Dignity Health

Subsidiaries

7 CA Community
Hospitals + AZ
Community
Hospital

Joint
Ventures

Other
Subsidiaries

Joint
Ventures

4 CA Hospital
Subsidiaries

 Major Provisions of the Ministry Alignment Agreement
The major provisions of the Ministry Alignment Agreement, dated December 6, 2017, include
the following:
Structures and Responsibilities


Catholic Health Care Federation (CHCF)
o CHCF, as a public juridic person, shall be the Catholic canonical sponsor of
System Corporation, and shall serve as the canonical sponsor of all of the
Catholic ministries that are a part of the Ministry Alignment Agreement;
o CHCF’s governance composition will be reconstituted after the Effective Date of
the Ministry Alignment Agreement:
o Dignity Health and CHI shall each select six individuals from their existing
governing bodies to serve as the initial CHCF members. In addition, the
members of CHCF shall also include the current president and CEO of
Dignity Health, and the current CEO of CHI, for a total of fourteen
members. No later than twelve months after the Effective Date, CHCF
shall approve and appoint one individual who was previously neither a
member of CHCF, nor the board of directors of Dignity Health or CHI to
serve as the fifteenth CHCF member;
o CHCF shall continue to provide for the participation of its congregations, and
shall admit the six congregations of Women’s Religious as additional
participating congregations; and
o CHCF reserves the rights to approve or remove any member of the Board of
Stewardship Trustees and veto any amendments or changes to Dignity Health’s
Statement of Common Values.

● System Corporation
o System Corporation, formerly known as Catholic Health Initiatives, shall become
the parent entity and the surviving corporation;
o System Corporation shall be a ministry of the Catholic Church and shall be
subject to the ERDs;
o System Corporation shall be governed by a board called the Board of
Stewardship Trustee that shall consist of the same persons who serve as the
CHCF members; and
14

 o Under the supervision of the CHCF, the Board of Stewardship Trustee reserves
the rights to control or manage the property, affairs and activities of System
Corporation. Responsibilities include approving the policies of System
Corporation, developing System Corporation’s strategic plan, and approving the
System Corporation’s articles of incorporation and bylaws.
● Dignity Health
o Dignity Health shall continue to be a California nonprofit corporation with
federal tax-exempt 501 (c)(3) status until after debt consolidation between
Dignity Health and CHI, at which point Dignity Health will merge into System
Corporation;
o As of the Effective Date:
o Dignity Health shall transfer all of the assets and liabilities associated with
the Dignity Health businesses and operations of the following California
non-Catholic hospitals to IHO:
● California Hospital Medical Center;
● French Hospital Medical Center;
● Glendale Memorial Hospital and Health Center;
● Methodist Hospital of Sacramento;
● Northridge Hospital Medical Center;
● Sequoia Hospital; and
● Woodland Memorial Hospital.
o Dignity Health shall cause the four subsidiary hospitals that are
separately incorporated, Bakersfield Memorial Hospital, Community
Hospital of San Bernardino, Saint Francis Memorial Hospital, and Sierra
Nevada Memorial-Miners Hospital, to first substitute its membership
from Dignity Health to IHO, until after debt consolidation between
Dignity Health and CHI, at which point these four subsidiary hospitals will
merge into IHO; and
o Marian Regional Medical Center, Arroyo Grande Campus, a non-Catholic
hospital, will remain with Dignity Health under a consolidated license
15

 with Marian Regional Medical Center, a Catholic hospital. Marian
Regional Medical Center, Arroyo Grande Campus will not adhere to the
ERDs. It will adopt or retain Dignity Health’s Statement of Common
Values. It does not offer obstetrics or women’s healthcare services.
o Dignity Health’s nineteen Catholic hospitals shall remain a ministry of the
Catholic Church and subject to the ERDs;
o System Corporation (after the transfers of the community hospitals to IHO) shall
become the sole corporate member of Dignity Health; and
o Dignity Health shall be governed by a board consisting of the same individuals
who are serving as the board for System Corporation and are also the members
of CHCF.
● Integrated Healthcare Operations
o IHO was formed by Dignity Health prior to the signing date without involvement,
input, or direction from CHI. IHO shall continue to be a Colorado nonprofit
corporation;
o IHO and its subsidiaries shall not become ministries of the Catholic Church, shall
not use the name “Catholic” for their respective public businesses, shall not be
subject to the ERDs, and shall operate consistent with Dignity Health’s Statement
of Common Values;
o IHO shall be governed by a board of directors consisting of individuals who shall:
o Be initially appointed by Dignity Health and then nominated by the board
of directors of IHO or a committee thereof;
o Serve in their individual capacities and not in any manner as a
representative of System Corporation; and
o Not contemporaneously serve; as a CHCF Member, or on the board of
System Corporation, Dignity Health, nor any other subsidiary of System
Corporation;
o After the Effective Date, a majority of the members of the IHO Board who are
subject to nomination or re-appointment shall be nominated by the IHO Board
then in effect, subject to the acceptance (or rejection) of a majority of such
nominees by the board of System Corporation;

16

 o IHO is anticipated to operate on a collaborative basis with System Corporation.
Neither CHCF, System Corporation, Dignity Health, or any other subsidiary of
System Corporation shall be the corporate member of IHO; and
o Prior to the Effective Date of the contemplated merger, Dignity Health
shall require IHO and each of its subsidiary operating hospitals to create a
Community Hospital Oversight Committee for each hospital. These
committees will act as a separate governance body to oversee the
operations, management, and financial results related to the Designated
Procedures performed in each community hospital.
o With respect to the Designated Procedures performed at each
community hospital:
● Such community hospital shall separately account for and
regularly report to the Community Hospital Oversight Committee
on the net revenues and expenses reasonably allocated to such
Designated Procedures together with the net financial results (i.e.
either a net profit or net loss);

● The Community Hospital Oversight Committee shall donate any
net profits to one or more healthcare related tax-exempt charities
that provide or advocate for activities, services, or procedures
benefitting the communities served by the hospital and that are
not inconsistent with the ERDs.
o On an annual basis, and not more than four months following the end of
each fiscal year of IHO, each Community Hospital Oversight Committee
shall prepare and deliver a written certification to the IHO Board and to
the Local Hospital Community Board or the applicable board of one of the
four subsidiaries:
● The Community Hospital Oversight Committee has not amended
its charter in any manner that violates or otherwise modifies the
structure or authorities contained in the IHO bylaws;
● The composition of the Community Hospital Oversight Committee
complies with the requirements; and
● All donations or grants (if any) of the net profits from the
performance of the Designated Procedures were contributed to
one or more healthcare related tax-exempt charities.

17

 o IHO reserves the right to approve changes of non-Catholic hospitals, its
subsidiaries and its joint ventures. Changes include changing the mission or
philosophical direction of entities, and approval or removal of entities under
IHO. Modifications to Dignity Health’s Statement of Common Values must be
approved by the board of System Corporation and can be vetoed by CHCF.
● Port City Operating Company, LLC
o St. Joseph Medical Center of Stockton and St. Joseph Behavioral Health
Center are owned by Port City Operating Company, LLC, a joint venture
between Kaiser Foundation Hospitals and Dignity Health. Dignity Health
owns 80% of Port City Operating Company, LLC and Kaiser Foundation
Hospitals owns the remaining 20%. Dignity Health’s continued ownership in
Port City Operating Company, LLC after a change of control of Dignity Health
will be subject to Kaiser Foundation Hospitals’ consent; and
o Dignity Health’s ownership interest of Port City Operating Company, LLC will
transfer to System Corporation.
● CHI Regional Corporations
o Each of the CHI Regional Corporations shall continue to be nonprofit
corporations organized in their respective states of incorporation until Dignity
Health and CHI consolidate debt. Afterwards, the CHI Regional Corporations will
merge into System Corporation.
● Mark Twain Medical Center
o Dignity Health and CHI acknowledge that the continued management of Mark
Twain Medical Center by Dignity Health after a change of control of Dignity
Health may be subject to consent from outside parties.

18

 Dignity Health Commitments
● Licensed Acute Care Hospital Commitments
o For a period of five years from the Effective Date of the transaction:
▪

The System Corporation and Dignity Health shall continue to operate and
maintain each Dignity Health owned hospital as a licensed general acute
care hospital;

▪

IHO shall continue to operate and maintain each IHO owned hospital as a
licensed general acute care hospital; and

▪

IHO and each IHO subsidiary shall continue to operate and maintain the
IHO subsidiary hospital as a licensed general acute care hospital.

● Licensed Specialty Service Commitments and Additional Specialty Services
Commitments
o For a period of five years from the Effective Date of the transaction:
▪

System Corporation and Dignity Health, with respect to the Dignity
Health owned hospitals, IHO owned hospitals, and the IHO subsidiary
hospitals shall continue to operate, provide and maintain the following
services at each California hospital:
● Twenty-four-hour emergency medical services at current
licensure, with the current number of emergency treatment
stations, the current types and levels of emergency medical
services, and the current designations or certifications associated
with such emergency medical services;
● Core specialty and additional specialty healthcare services at
current licensure and designation with current minimum types
and/or levels of services21; and
● Additional specialty healthcare services at current licensure and
designation with current types and/or levels of services.

21

See the “Assessment of Potential Issues Associated with the Availability or Accessibility of Healthcare Services” for a complete listing of
commitments made by Dignity Health for Methodist Hospital of Sacramento, Mercy San Juan Medical Centers, Mercy Hospital of Folsom and
Mercy General Hospital.

19

 ● Women's Healthcare Services Commitments
o For a period of five years from the Effective Date:
▪ System Corporation and Dignity Health, with respect to the Dignity
Health owned hospitals, IHO owned hospitals, and the IHO subsidiary
hospitals, shall continue to provide women's healthcare services.
▪

Those Dignity Health California hospitals that are non-Catholic shall retain
their identity as community hospitals and shall not become ministries of
the Catholic Church, nor be subject to the ERDs. In addition, they will
retain or adopt Dignity Health’s Statement of Common Values.

● Medicare & Medi-Cal Commitment
o For a period of five years from the Effective Date of the transaction:
▪

System Corporation and Dignity Health, with respect to the Dignity
Health owned hospitals, IHO owned hospitals, and the IHO subsidiary
hospitals, shall:
● Continue to be certified to participate in the Medicare program;
● Continue to be certified to participate in the Medi-Cal program;
and
● Continue to have and maintain their respective Medi-Cal
Managed Care contracts in effect as of the signing date.

● City/County Contract Commitment:
o For a period of five years from the Effective Date of the transaction:
▪

System Corporation and Dignity Health, with respect to the Dignity
Health owned hospitals, IHO owned hospitals, and the IHO subsidiary
hospitals, shall maintain healthcare-related services contracts, with any
city or county in the State of California as of the signing date.

● Charity Care Commitment
o For the six fiscal years from the Effective Date, System Corporation and Dignity
Health, with respect to the Dignity Health owned hospitals, IHO owned hospitals,
and the IHO subsidiary hospitals, in California shall:

20

 ▪

Provide an annual amount of charity care at each hospital equal to or
greater than the average annual amount of charity care provided by such
hospital during the three fiscal years prior to the signing date and
adjusted for cost-of-living-adjustments.

● Community Benefit Program Commitment
o For a period of six fiscal years from the Effective Date, System Corporation and
Dignity Health, with respect to the Dignity Health owned hospitals, IHO owned
hospitals, and the IHO subsidiary hospitals in California, shall provide an annual
amount of community benefit services at each such Dignity Health California
Hospital equal to or greater than the average annual amount of community
benefit services provided by hospital during the three fiscal years prior to the
signing date and adjusted for cost-of-living adjustments.
● Medical Staff and Related Commitments
o System Corporation and Dignity Health, with respect to the Dignity Health
owned hospitals, IHO owned hospitals, and the IHO subsidiary hospitals in
California, shall maintain privileges for the current medical staff members of
each such hospital who are in good standing as of the Effective Date.
● LGBT Non-Discrimination Commitments
o There shall be no discrimination against any lesbian, gay, bisexual, or
transgender individuals at any Dignity Health California hospitals. System
Corporation and Dignity Health, with respect to the Dignity Health owned
hospitals, and IHO with respect to the IHO owned hospitals and the IHO
subsidiary hospitals, shall cause this prohibition to be explicitly set forth in the
written policies applicable to such hospitals, adhered to and strictly enforced.
● Seismic Compliance Commitments
o System Corporation, Dignity Health and IHO shall commit the necessary
investments required to meet and maintain OSHPD seismic compliance
requirements at each Dignity Health California hospital until January 1, 2030
● Union Commitments
○ Dignity Health and CHI agree that the collective bargaining agreements in effect
as of the Effective Date shall remain in full force and effect following the
Effective Date in accordance with their respective terms.
● Hospital Quality Assurance Fee Program Participation
21

 ○ System Corporation, Dignity Health and IHO commit to continue participation in
the California Department of Health Care Services’ Hospital Quality Assurance
Fee Program for five years for all California hospitals.
Use of Net Sale Proceeds
There will be no net proceeds as a result of the proposed transaction.

22

 Profile of Catholic Health Initiatives
Overview
CHI is a nonprofit, faith-based health system that formed in 1996 through the consolidation of
three Catholic health systems: Catholic Health Corporation, Franciscan Health System, and
Sisters of Charity Health System.
CHI, headquartered in Englewood, Colorado, has a service area that covers approximately 54
million people and operates acute care facilities in 13 states. CHI’s network consists of 97 acute
care facilities, academic health centers and major teaching hospitals, critical-access facilities,
community health-service organizations, nursing colleges, and senior living communities. The
health system has more than 95,000 employees, including approximately 4,700 employed
physicians and advanced practice clinicians.
CHI Acute Care Facilities
ACUTE CARE
FACILITIES
4
12
21
13
4
10
5
2
16
10

REGION
Arkansas
Colorado and Kansas
Iowa and Nebraska
Kentucky
Minnesota
North Dakota
Ohio
Tennessee
Texas
Oregon and Washington
Source: 2017 CHI Annual Report

CHI OPERATIONS
Acute Care Facilities
Home Services Location
Critical- Access Hospitals
Long-Term Facilities
Clinical Integrated Networks
Academic Medical Centers a Major Teaching Hospital
Community Health Services Organizations

97
52
30
16
11
3
2

Source: 2017 CHI Annual Report

Key Statistics
In Fiscal Year (FY) 2017, CHI reported growth in the number of admissions, outpatient
emergency visits, outpatient non-emergency visits, physician office visits, the number of fulltime equivalent employees, and total employees overall compared to FY 2016. CHI reported a
decrease in acute patient days, average daily census, residential days, and long-term care days.
23

 CHI STATISTICAL HIGHLIGHTS FY 2016 – FY 2017
Fiscal Year ended June 30, 2017
FY 2016
FY 2017
Acute Patient Days
2,382,402
2,366,980
Acute Average Daily Census
6,527
6,485
Acute Admissions
498,464
504,593
Acute Average Length of stay, in days
4.8
4.7
Outpatient emergency visits
1,951,714
1,966,342
Outpatient non-emergency visits
5,557,647
5,804,586
Physician office visits
9,635,875 10,540,482
Residential days
751,072
665,885
Long-term care days
503,450
483,151
Full-time equivalent employees
79,194
84,463
Employees
93,697
95,968
Acute inpatient revenues as a percentage of total
44.70%
44.70%

Change
-0.6%
-0.6%
1.2%
-2.1%
0.7%
4.4%
9.4%
-11.3%
-4.0%
6.7%
2.4%
-

Source: CHI 2017 Annual Report

Payer Mix
The following chart represents the gross revenue by payer for CHl's consolidated operations for
the FY 2017.

Gross Revenue By Payer
Commercial
Managed Care
29%

Commercial
5%
Self-pay
4%

Medicaid
16%

Other
4%
Medicare
42%

Source: CHI Annual Report

24

 Financial Profile
CHI’s audited consolidated financial statements show the following system-wide performance
of CHI and its affiliates:
CHI COMBINED STATEMENT OF OPERATIONS
FY 2016 – FY 2017 (In Thousands)
Unrestricted Revenues and Support
Net Patient Service Revenue Less Bad Debt Provision
Donations
Changes in Equity of Unconsolidated Organizations
Gains on Business Combinations
Hospital Ancillary Revenues
Other
Total Operating Revenues
Expenses
Salaries and Wages
Employee Benefits
Purchased Services, Medical Professional Fees, Medical Claims and Consulting
Supplies
Utilities
Rentals, Leases, Maintenance and Insurance
Depreciation and Amortization
Interest
Other
Restructuring, Impairment and Other Losses
Total Expenses

FY 2016
$13,847,027
$36,983
$133,375
$223,036
$351,509
$597,657
$15,189,587

FY 2017
$14,450,868
$30,954
$48,404
$339,072
$678,166
$15,547,464

$6,117,712
$1,182,203
$2,232,689
$2,490,524
$212,732
$898,020
$833,394
$281,581
$1,019,385
$292,758
$15,560,998

$6,294,834
$1,201,044
$2,402,478
$2,550,328
$210,285
$901,272
$846,291
$295,476
$1,056,536
$374,167
$16,132,711

Income From Operations

($371,411)

($585,247)

Non-operating Income (Loss)
Investment Income (Loss), net
Loss on early extinguishment of debt
Realized and Unrealized Gains (Losses) on Interest Rate Swaps
Other Non-operating Gains (Losses)
Total Non-operating Income (Loss)

($3,384)
($29,469)
($154,816)
($16,491)
($204,160)

$638,519
($19,586)
$92,698
$2,006
$713,637

($575,571)

$128,390

Excess of revenues over Expenses
Source: CHI Audited Financial Statements

● Net Patient Service Revenue (less provision for bad debts) of $14.5 billion in FY 2017
represents a net increase of approximately $600 million, or 4.4%, as compared to FY
2016. Total operating revenues increased by $358 million, or 2.4%, from $15.2 billion in
FY 2016 to $15.5 billion in FY 2017;
Total expenses increased by 3.7% from $15.6 billion in FY 2016 to $16.1 billion in FY 2017. CHI’s
salaries, wages and employee benefits expense accounted for 46% of total expenses;
● In FY 2017, CHI realized a non-operating gain of approximately $714 million, a
substantial increase from the non-operating loss of $204 million loss in FY 2016; and
● Excess revenue over expenses increased from a loss of approximately $576 million in FY
2016 to a gain of approximately $128 million in FY 2017. This is mainly due to an
increase in non-operating revenue.
25

 Profile of Dignity Health
Dignity Health is a California nonprofit public benefit corporation that traces its history to the
Sisters of Mercy, founded by Catherine McAuley in Dublin, Ireland in 1831. On December 8,
1854, eight Sisters of Mercy left Ireland and arrived in San Francisco, California to begin caring
for residents struck by influenza, cholera and typhoid. The Sisters of Mercy opened St. Mary’s
Hospital, the oldest operating hospital in San Francisco, on July 27, 1857.
Today, Dignity Health has grown to be one of the largest health systems in the United States.
Dignity Health provides healthcare services in California, Arizona and Nevada. In California,
Dignity Health owns and operates 31 hospitals across 17 counties with an estimated 11,500
physicians on its hospitals’ medical staff. Dignity Health also operates five general acute care
hospitals in Arizona and three in Nevada.

26

 Payer Mix
The following chart shows inpatient discharges by payer for Dignity Health’s consolidated
California operations for FY 2016.
DIGNITY HEALTH TOTAL PAYER MIX COMPARISON FY 201622
Dignity Health FY 2016

Medi-Cal Traditional
Medi-Cal Managed Care
Medi-Cal Total
Medicare Traditional
Medicare Managed Care
Medicare Total
Third-Party Managed Care
Third-Party Managed Care Total
Third-Party Traditional
Other Payers
Other Indigent
County Indigent
Other Total
Total

California FY 20161

Discharges

% of
Total

Discharges

% of
Total

42,492
65,590
108,082
88,052
27,196
115,248
47,682
47,682
5,245
2,495
1,344
76
9,160
280,172

15.20%
23.40%
38.60%
31.40%
9.70%
41.10%
17.00%
17.00%
1.90%
0.90%
0.50%
0.00%
3.30%
100%

441,300
590,581
1,031,881
829,621
315,579
1,145,200
648,533
648,533
100,382
44,809
17,246
15,160
177,597
3,003,211

14.70%
19.70%
34.40%
27.60%
10.50%
38.10%
21.60%
21.60%
3.30%
1.50%
0.60%
0.50%
5.90%
100%

Source: OSHPD Disclosure Reports, FY 2016
1

FY 2017 California data was not available when the data was collected to prepare this report.

● Dignity Health’s largest payer in California by percentage of inpatient discharges is
Medicare (41.1%), followed by Medi-Cal (38.6%), and Third-Party Managed Care
(17.0%);
● Dignity Health’s California hospitals care for 10.5% of all California Medi-Cal inpatient
discharges;
● Dignity Health’s California hospitals had 10.1% of all California Medicare inpatient
discharges; and
● In FY 2016, Dignity Health’s California hospitals cared for 9.3% of all inpatient discharges
in California.

22

Fiscal Year from July 1 through June 30.

27

 Financial Profile
Dignity Health’s audited consolidated financial statements show the following system-wide
performance of Dignity Health and its affiliates.
DIGNITY HEALTH COMBINED STATEMENT OF OPERATIONS
FY 2016 - FY 2017 (In Thousands)
Unrestricted Revenues and Support
Net Patient Service Revenue Less Bad Debt Provision
Premium Revenue
Revenue from health-related activities, net
Other Revenue
Contributions
Total Unrestricted Revenues And Support
Expenses
Salaries and Benefits
Supplies
Purchased Services and Other
Depreciation and Amortization
Interest Expense, net
Total Expenses

FY 2016
$11,542,262
$633,395
$66,586
$376,580
$17,452
$12,636,275

FY 2017
$11,572,387
$755,427
$139,013
$364,631
$18,649
$12,850,107

$6,581,323
$1,769,212
$3,497,502
$581,624
$270,034
$12,699,695

$6,883,671
$1,850,519
$3,454,313
$606,370
$122,018
$12,916,891

($63,420)

($66,784)

Non-operating Income (Loss)
Investment Income (Loss), net
Loss on early extinguishment of debt
Income Tax Expense
Total Non-operating Income (Loss)

($123,869)
($14,189)
($138,058)

$555,538
($48,012)
($15,024)
$492,502

Excess of Revenues over Expenses

($201,478)

$425,718

Income From Operations

Source: Dignity Health Audited Financial Statements

● Net patient service revenue, less bad debt provision, increased slightly to $11.6 billion in FY
2017. Total unrestricted revenues and support increased by $214 million from $12.6 billion
in FY 2016 to $12.9 billion in FY 2017;
● Total expenses increased by 1.7% from $12.7 billion in FY 2016 to $12.9 billion in FY 2017.
Dignity Health’s salaries, wages and benefits expense accounted for approximately 53% of
total expenses;
● In FY 2017, Dignity Health realized a net non-operating gain of $493 million, representing a
substantial increase from the net non-operating loss of $138 million in FY 2016; and
● Excess revenue over expenses increased from a loss of $201 million in FY 2016 to a gain of
$426 million in FY 2017, mainly due to an increase in investment income in FY 2017.

28

 Dignity Health’s California Hospitals Overview
The following table lists the location of each Dignity Health owned and managed hospital in
California.
DIGNITY HEALTH'S OWNED & OPERATED CALIFORNIA HOSPITALS
Hospital
County
Bakersfield Memorial Hospital
Kern County
Mercy Hospital
Kern County
Mercy Southwest Hospital
Kern County
California Hospital Medical Center
Los Angeles
Glendale Memorial Hospital
Los Angeles
Northridge Hospital Medical Center
Los Angeles
St. Mary Medical Center
Los Angeles
Mercy Medical Center Merced
Merced County
Sierra Nevada Memorial Hospital
Nevada County
Marian Regional Medical Center, Arroyo Grande Campus San Luis Obispo County
French Hospital Medical Center
San Luis Obispo County
Mercy General Hospital
Sacramento County
Mercy Hospital of Folsom
Sacramento County
Mercy San Juan Medical Center
Sacramento County
Methodist Hospital of Sacramento
Sacramento County
Community Hospital of San Bernardino
San Bernardino
St. Bernardine Medical Center
San Bernardino
Saint Francis Memorial Hospital
San Francisco County
St. Mary's Medical Center
San Francisco County
St. Joseph's Behavioral Health Center
San Joaquin County
Sequoia Hospital
San Mateo County
St. Joseph's Medical Center
San Joaquin County
Marian Regional Medical Center
Santa Barbara County
Marian Regional Medical Center West
Santa Barbara County
Dominican Hospital
Santa Cruz County
Mercy Medical Center Redding
Shasta County
Mercy Medical Center Mt Shasta
Siskiyou County
St. Elizabeth Community Hospital
Tehama County
St. John's Pleasant Valley Hospital
Ventura County
St. John's Regional Medical Center
Ventura County
Woodland Memorial Hospital
Yolo County
Source: Dignity Health

29

City
Bakersfield
Bakersfield
Bakersfield
Los Angeles
Glendale
Northridge
Long Beach
Merced
Grass Valley
Arroyo Grande
San Luis Obispo
Sacramento
Folsom
Carmichael
Sacramento
San Bernardino
San Bernardino
San Francisco
San Francisco
Stockton
Redwood City
Stockton
Santa Maria
Santa Maria
Santa Cruz
Redding
Mt. Shasta
Red Bluff
Camarillo
Oxnard
Woodland

 Analysis of Dignity Health’s Sacramento County Hospital Market Share
Sacramento County is comprised of over 1.4 million residents and encompasses over 1,000
square miles. The map below depicts the four Dignity Health general acute care facilities
located in Sacramento County and their respective service areas.

30

 There are a total of 16 general acute care facilities located within Sacramento County, four of
which are Dignity Health hospitals. These four hospitals are Methodist Hospital of Sacramento,
Mercy San Juan Medical Center, Mercy Hospital of Folsom and Mercy General Hospital. The
four hospitals have a combined 33.8% market share of inpatient discharges in Sacramento
County. The following table shows Sacramento County inpatient market share for calendar year
(CY) 2016, the most recent data available from OSHPD. A profile for each Dignity Health
hospital located in Sacramento County is described in the following sections.

SACRAMENTO COUNTY
MARKET SHARE BY HOSPITAL CY 2016
Hospital
Sutter Medical Center, Sacramento
UC Davis Medical Center
Mercy San Juan Medical Center1
Kaiser Foundation Hospital - South Sacramento
Kaiser Foundation Hospital - Roseville
Mercy General Hospital1
Methodist Hospital of Sacramento1
Kaiser Foundation Hospital - Sacramento
Sutter Roseville Medical Center
Mercy Hospital Of Folsom1
Sierra Vista Hospital
Heritage Oaks Hospital
Sutter Center For Psychiatry
Adventist Health Lodi Memorial
Woodland Memorial Hospital1
UCSF Medical Center
St. Joseph's Behavioral Health Center1
Fremont Hospital
Sutter Davis Hospital
Adventist Health Vallejo
Crestwood Psychiatric Health Facility-Carmichael
Sacramento Mental Health Treatment Center
Crestwood Psychiatric Health Facility-Sacramento
Shriners Hospitals for Children Northern Calif.
San Joaquin General Hospital
Aurora Behavioral Healthcare-Santa Rosa, LLC
California Pacific Med Ctr-Pacific Campus
Stanford Health Care
Kaiser Foundation Hospital - Rehabilitation Center Vallejo
Lucile Salter Packard Children's Hosp. at Stanford
Vibra Hospital of Sacramento
St. Joseph's Medical Center of Stockton1
All Other
Total Discharges
Total Dignity Health Discharges
Source: OSHPD Patient Discharge Database
Note: Excludes normal newborns
1 Dignity Health Hospital

31

CY 2016
Discharges
21,820
16,934
15,923
13,111
12,044
11,101
10,209
8,126
6,361
4,425
3,328
2,422
1,628
911
772
679
502
471
469
432
417
391
354
324
303
271
215
205
184
161
152
141
3,620
138,406
43,258

Market
Share
15.8%
12.2%
11.5%
9.5%
8.7%
8.0%
7.4%
5.9%
4.6%
3.2%
2.4%
1.7%
1.2%
0.7%
0.6%
0.5%
0.4%
0.3%
0.3%
0.3%
0.3%
0.3%
0.3%
0.2%
0.2%
0.2%
0.2%
0.1%
0.1%
0.1%
0.1%
0.1%
2.6%
100%
33.8%

 Profile of Methodist Hospital of Sacramento
Overview
Methodist Hospital of Sacramento is a general acute care hospital located at 500 Hospital Drive
in Sacramento, California. The Hospital was established in 1973.

Today, Methodist Hospital of Sacramento offers a range of services including: a Primary Stroke
Center, obstetrics, critical care medicine and skilled nursing. The Hospital has 10 surgical
operating rooms and a “basic” emergency department23 with 29 emergency treatment stations.
According to Methodist Hospital of Sacramento’s current hospital license, it is licensed for 329
beds as shown below.

METHODIST HOSPITAL OF SACRAMENTO
LICENSED BED DISTRIBUTION 2018
Licensed Bed Type
Number of Beds1
General Acute Care Beds
Neonatal Intensive Care
12
Perinatal
22
Intensive Care
10
Coronary Care
10
Unspecified General Acute Care
104
Total General Acute Care Beds
158
Skilled Nursing
171
Total Licensed Beds
329
1

23

2018 Hospital License

A “basic” emergency department provides emergency medical care in a specifically designated part of a hospital that is staffed and equipped
at all times to provide prompt care for any patient presenting urgent medical problems.

32

 Key Statistics
Methodist Hospital of Sacramento reported 10,582 inpatient discharges, 95,239 patient days,
and an average daily census of 261 patients (approximately 79% occupancy) for FY 2017.

Inpatient Discharges
Licensed Beds
Patient Days
Average Daily Census
Occupancy
Average Length of Stay
Emergency Service Visits
Total Live Births

METHODIST HOSPITAL OF SACRAMENTO
KEY STATISTICS FY 2015 - FY 20171
FY 2015
11,345
329
96,434
264
80.3%
8.5
66,733
1,994

FY 2016
11,072
329
95,209
261
79.3%
8.6
66,511
1,947

FY 2017
10,582
329
95,239
261
79.3%
9.0
66,123
1,567

Sources: OSHPD Disclosure Reports, FY 2015 - FY 2017
1
FY 2015 and FY 2016 data are from audited OSHPD Disclosure Reports whereas FY 2017 data is from unaudited.

33



Since FY 2015, inpatient discharges have decreased by 7% while patient days have
decreased by 1%;



In FY 2017, 66,123 emergency service visits were reported, a 1% decrease from FY 2015;



Between FY 2015 and FY 2017, total live births decreased by 21%, with an average of
1,836 live births annually.

 Patient Utilization Trends
The following table shows FY 2013 - FY 2017 patient volume trends at Methodist Hospital of
Sacramento. According to the Hospital management, some neonatal intensive care, intensive
care and obstetrics discharges were improperly reported to OSHPD as medical/surgical
discharges during FY 2015 and FY 2016 and replaced with N/A in the table below.

PATIENT DAYS
Medical/Surgical
Neonatal Intensive Care
Intensive Care
Obstetrics
Skilled Nursing
Total
DISCHARGES
Medical/Surgical
Neonatal Intensive Care
Intensive Care
Obstetrics
Skilled Nursing
Total
AVERAGE LENGTH OF STAY
Medical/Surgical2
Neonatal Intensive Care
Intensive Care
Obstetrics
Skilled Nursing
Total
AVERAGE DAILY CENSUS
Medical/Surgical2
Neonatal Intensive Care
Intensive Care
Obstetrics
Skilled Nursing
Total
OTHER SERVICES
Inpatient Surgeries
Outpatient Surgeries
Emergency Services Visits
Total Live Births

METHODIST HOSPITAL OF SACRAMENTO
SERVICE VOLUMES FY 2013 - FY 20171
FY 2013
FY 2014
24,357
26,503
2,147
1,828
4,728
5,126
4,384
4,209
55,068
56,306
90,684
93,972

FY 2015
27,979
1,641
5,626
4,483
56,705
96,434

FY 2016
27,605
1,818
5,186
4,462
56,138
95,209

FY 2017
28,204
1,390
4,641
3,524
57,480
95,239

7,529
183
318
1,855
580
10,465

7,853
168
426
1,858
628
10,933

N/A
N/A
N/A
N/A
718
11,345

N/A
N/A
N/A
N/A
710
11,072

7,623
190
476
1,601
692
10,582

3.2
11.7
14.9
2.4
94.9
8.7

3.4
10.9
12.0
2.3
89.7
8.6

N/A
N/A
N/A
N/A
79.0
8.5

N/A
N/A
N/A
N/A
79.1
8.6

3.7
7.3
9.8
2.2
83.1
9.0

66.7
5.9
13.0
12.0
150.9
248

72.6
5.0
14.0
11.5
154.3
257

N/A
N/A
N/A
N/A
155.4
264

N/A
N/A
N/A
N/A
153.8
261

77.3
3.8
12.7
9.7
157.5
261

2,193
3,526
57,604
1,812

2,135
3,808
58,857
1,776

2,150
3,581
66,733
1,994

2,174
3,693
66,511
1,947

2,327
3,977
66,123
1,567

Sources: OSHPD Disclosure Reports, FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.
2 Includes Definitive Observation Beds

A review of Methodist Hospital of Sacramento’s historical utilization trends between FY 2013
and FY 2017 supports the following conclusions:

34



Total patient days have increased by 5% but decreased the last three years by 1%;



Inpatient discharges have increased by 1%;

 

The average daily census increased by 5% from 248 patients in FY 2013 to 261 patients
in FY 2017;



Emergency service visits have increased by 15% to 66,123 visits in FY 2017; and



The overall average length of stay is impacted by skilled nursing patients, which
generally remain in the hospital for longer time periods.

Financial Profile
Over the last five fiscal years, Methodist Hospital of Sacramento’s net income has had a loss
ranging from negative net income of $5.8 million in FY 2013 to $11.8 million in FY 2017.
Between FY 2013 and FY 2017, net patient revenue and total operating revenue increased by
nearly 20% and 19% respectively. Over the same period, the Hospital’s operating expenses
increased by 22% from $250.9 million in FY 2013 to $304.8 million in FY 2017. Other operating
revenue24 decreased by 37% from $2.7 million in FY 2013 to $1.7 million.
The Hospital’s current-ratio25 has increased over the last five years from 1.26 in FY 2013 to 1.68
in FY 2017. The California average in FY 2016 was 1.56. The Hospital’s percentage of bad debt is
0.3% and lower than the statewide average of 0.8%.
METHODIST HOSPITAL OF SACRAMENTO
FINANCIAL AND RATIO ANALYSIS FY 2013 - FY 20171
FY 2013
90,684
10,465
8.7

FY 2014
93,972
10,933
8.6

FY 2015
96,434
11,345
8.5

FY 2016
95,209
11,072
8.6

FY 2017
95,239
10,582
9.0

$241,806,703
$2,702,520
$244,509,223
$250,916,265
($6,407,042)
$649,468
($5,757,574)

$238,033,347
$2,408,275
$240,441,622
$252,803,508
($12,361,886)
$267,781
($12,094,105)

$290,174,480
$2,099,410
$292,273,890
$288,867,763
$3,406,127
$190,963
$3,597,090

$286,235,979
$2,413,714
$288,649,693
$296,578,869
($7,929,176)
$1,605,372
($6,323,804)

$289,737,642
$1,716,439
$291,454,081
$304,813,936
($13,359,855)
$1,512,713
($11,847,142)

Current Ratio
1.26
1.44
1.41
1.45
Days in A/R
48.7
53.0
42.3
44.2
Bad Debt Rate
3.2%
2.6%
1.3%
1.3%
Operating Margin
-2.62%
-5.14%
1.17%
-2.75%
Source: OSHPD Disclosure Reports, FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.
2 FY 2017 California data was not available when the data was collected to prepare this report.

1.68
43.7
0.3%
-4.58%

Patient Days
Discharges
ALOS
Net Patient Revenue
Other Operating Revenue
Total Operating Revenue
Operating Expenses
Net from Operations
Net Non-Operating Revenues and Expenses
Net Income

24

2016
California
Average2
1.56
57.1
0.8%
2.74%

Other operating revenue represents amounts received for services that are central to the provision of healthcare services but are not directly
related to patient care.
25 The current ratio compares a company’s total assets to its current liabilities to measure its ability to pay short-term and long-term debt
obligations. A low current ratio of less than 1.0 could indicate that a company may have difficulty meeting its current obligations. The higher the
current ratio, the more capable the company is of paying its obligations as it has a larger proportion of assets relative to its liabilities.

35

 Cost of Hospital Services
Methodist Hospital of Sacramento’s operating cost of services includes both inpatient and
outpatient care. In FY 2017, 49% of total costs were associated with Medi-Cal, followed by 34%
with Medicare, and 16% with Third-Party.

Operating Expenses

METHODIST HOSPITAL OF SACRAMENTO
OPERATING EXPENSES BY PAYER CATEGORY FY 2013 - FY 20171
FY 2013
FY 2014
FY 2015
FY 2016
$250,916,265
$252,803,508
$288,867,763 $296,578,869

Cost of Services By Payer:
Medicare
Medi-Cal
County Indigent
Third-Party
Other Indigent
All Other Payers

$79,225,798
$88,918,146
$9,884,888
$58,745,155
$3,776,511
$10,365,767

$82,049,277
$101,220,211
$10,428,091
$42,448,503
$3,582,127
$13,075,300

$98,325,836
$138,158,901
$42,541,241
$3,577,565
$6,264,221

$98,578,915
$144,477,575
$44,652,068
$1,907,983
$6,962,328

FY 2017
$304,813,936

$102,394,700
$149,839,620
$1,866
$47,786,222
$2,719,624
$2,071,904

Source: OSHPD Disclosure Reports, FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.

Charity Care
The following table shows a comparison of charity care and bad debt for Methodist Hospital of
Sacramento to all general acute care hospitals in the State of California. The five-year (FY 2013
– FY 2017) average of charity care and bad debt, as a percentage of gross patient revenue, was
3.1% and higher than the four-year statewide average of 2.5%. According to OSHPD, “…the
determination of what is classified as charity care can be made by establishing whether or not
the patient has the ability to pay. The patient’s accounts receivable must be written off as bad
debt if the patient has the ability but is unwilling to pay off the account.”
METHODIST HOSPITAL OF SACRAMENTO
CHARITY CARE COMPARISON FY 2013 - FY 20171 (In Thousands)
FY 2013
FY 2014
Hospital
CA
Hospital
CA
Gross Patient Revenue
$1,038,204
$320,382,471
$1,097,751
$338,322,364
Charity
$17,931
$6,563,487
$16,784
$5,113,965
Bad Debt
$33,449
$5,891,632
$28,390
$4,365,936
Total Charity & Bad Debt
$51,380
$12,455,119
$45,175
$9,479,902
Charity Care as a % of Gross Patient Revenue
1.7%
2.0%
1.5%
1.5%
Bad Debt as a % of Gross Patient Revenue
3.2%
1.8%
2.6%
1.3%
Total as a % of Gross Patient Revenue
4.9%
3.9%
4.1%
2.8%
Uncompensated Care
Cost to Charge Ratio¹
23.9%
24.5%
22.8%
23.6%
Charity
$4,287
$1,608,711
$3,828
$1,207,919
Bad Debt
$7,997
$1,444,039
$6,476
$1,031,234
Total
$12,284
$3,052,750
$10,304
$2,239,153
Source: OSHPD Disclosure Reports FY 2013 - FY 2017
1
FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.
2
FY 2017 California data was not available when the data was collected to prepare this report.

FY 2015
Hospital
CA
$1,209,381
$365,501,463
$19,444
$3,441,227
$15,734
$3,262,642
$35,177
$6,703,869
1.6%
0.9%
1.3%
0.9%
2.9%
1.8%
23.7%
$4,610
$3,731
$8,341

24.1%
$828,647
$785,644
$1,614,292

FY 2016
Hospital
CA
$1,291,566
$396,427,743
$13,185
$3,457,868
$16,414
$3,108,971
$29,599
$6,566,839
1.0%
0.9%
1.3%
0.8%
2.3%
1.7%
22.8%
$3,003
$3,738
$6,742

23.8%
$822,627
$739,624
$1,562,251

FY 2017
Hospital
CA 2
$1,353,241
$13,903
$4,030
$17,933
1.0%
0.3%
1.3%
22.4%
$3,114
$903
$4,017

The following table shows the Hospital’s historical costs for charity care as reported to OSHPD.
Charity care costs have decreased from $4.3 million in FY 2013 to $3.1 million in FY 2017. The
average cost of charity care for the last five-year period was $3.8 million, while the three-year
average cost of charity care was $3.6 million.
36

-

 METHODIST HOSPITAL OF SACRAMENTO
COST OF CHARITY CARE FY 2013 - FY 20171
Charity Care
Charges
$13,903,288
$13,185,107
$19,443,696
$16,784,293
$17,931,292

Year
FY 2017
FY 2016
FY 2015
FY 2014
FY 2013
FY 2015 - FY 2017 Average
FY 2013 - FY 2017 Average

Cost to
Charge Ratio
22.4%
22.8%
23.7%
22.8%
23.9%

Cost of Charity
Care to the
Hospital
$3,114,044
$3,003,021
$4,610,487
$3,828,471
$4,287,012
$3,575,851
$3,768,607

Source: OSHPD Disclosure Reports FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.

In the application to the California Attorney General, Dignity Health reported the following
combined distribution of charity care costs by inpatient, outpatient, and emergency room
charges.
METHODIST HOSPITAL OF SACRAMENTO
COST OF CHARITY CARE BY SERVICE FY 2013 - FY 2017
Emergency
Inpatient
Outpatient
Room
FY 2017:
Cost of Charity
Visits/Discharges
FY 2016:
Cost of Charity
Visits/Discharges
FY 2015:
Cost of Charity
Visits/Discharges
FY 2014:
Cost of Charity
Visits/Discharges
FY 2013:
Cost of Charity
Visits/Discharges

Total Costs

$1,161,682
66

$783,111
422

$1,025,848
1,112

$2,970,641

$493,711
35

$489,603
302

$620,563
827

$1,603,877

$1,655,079
110

$784,981
417

$891,166
1,260

$3,331,226

$2,203,360
150

$783,453
421

$792,392
1,125

$3,779,205

$2,106,472
146

$798,343
455

$848,560
1,191

$3,753,375

Source: Dignity Health

Note that these totals are different than what Dignity Health reported to OSHPD. However,
after discussion with JD Healthcare Inc. and Vizient Inc., Dignity Health has acknowledged that
an error was made in its calculation of charity care costs. Dignity Health has stated that they
will comply with the charity care cost amounts determined in the manner described above.

37

 Community Benefit Services
In the last five years, Methodist Hospital of Sacramento has provided a significant contribution
for community benefit services. As shown in the table below, the average annual cost of
community benefit services over the last three years has been $4.8 million. The average annual
cost of community benefit services over the last five years has been $4.5 million.
METHODIST HOSPITAL OF SACRAMENTO
COMMUNITY BENEFIT SERVICES FY 2013 - FY 2017

Community Benefit Programs
Benefits for Living in Poverty
Benefits for Broader Community
Totals
Medi-Cal Provider Fee CHFT Grant Expense
Adjusted Totals
Source: Dignity Health

FY 2013
$2,711,754
$1,579,843
$4,291,597
($788,643)
$3,502,954

FY 2014
$2,143,158
$2,451,966
$4,595,124
($288,534)
$4,306,590

FY 2015
$3,199,527
$2,654,836
$5,854,363
($873,562)
$4,980,801

FY 2016
$2,640,212
$2,271,570
$4,911,782
($393,685)
$4,518,097

FY 2017
$1,322,174
$4,035,874
$5,358,048
($334,296)
$5,023,752

FY 2015 –
FY 2017
Average
$2,387,304
$2,987,427
$5,374,731
$4,840,883

● The Hospital’s five-year average cost of community benefit services for persons living in
poverty is $2.4 million per year;
● The Hospital’s five-year average cost of community benefit services for the broader
community is approximately $2.6 million; and
● Over the five-year period, the Hospital’s combined total cost of community benefit
services increased from approximately $3.5 million in FY 2013 to $5.0 million in FY 2017.

38

FY 2013 –
FY 2017
Average
$2,403,365
$2,598,818
$5,002,183
$4,466,439

 The Hospital’s community benefit services over the past five fiscal years included the following
programs over $10,000 in cost in FY 2017:
METHODIST HOSPITAL OF SACRAMENTO
COST OF COMMUNITY BENEFIT SERVICES FY 2013 - FY 2017
FY 2013
FY 2014
FY 2015
Services over $10,000 in cost in FY 2017:
Bruceville Enrollment Assistance
Cancer Focused Nurse Navigator
Charity Prescriptions
El Hogar Refer Net
Chronic Disease Self-Management Program
Lutheran Social Services Homeless Housing
Patient Navigator Program
Sacramento Community Partnerships
Transportation - Poor
Wellspace Interim Care Program
Counseling Service-Poor
Mercy Family Health Center (Family Practice Residency)
Renal Dialysis Services
Cash and In Kind Donations - Poor
Dignity Health Community Grants
In Kind Donation-Equipment/Supplies
Transitional Housing and Lodging -Poor
Community Benefit Assigned Staff
Mercy Faith & Health Partnerships
Mercy Heart and Vascular Institute
Professional & Medical Education - Other
Professional & Medical Training/Education-Med Students
Professional & Medical Training/Education-Nursing
Cash and In Kind Donations - Broader
Mercy Foundation Support

$78,628
$17,596
$574,817
$1,428,842
$18,501
$123,990
$924
$67,067
$10,226
$25,000
$115,775

$136,952
$16,583
$109,704
$932,279
$2,281,293
$16,980
$128,680
$2,496
$136,368
$16,328
$25,869
$118,775

$135,447
$15,534
$19,423
$122,698
$43,943
$785,782
$1,751,785
$240,458
$126,155
$1,334
$126,406
$15,391
$722,471
$4,331
$135,260

FY 2016

FY 2017

$166,500
$16,076
$15,681
$60,390
$61,200
$577,675
$1,268,545
$28,144
$126,963
$134,921
$15,750
$163,667
$460,047
$236,849
$2,187
$120,798

$188,827
$10,616
$16,199
$18,443
$22,977
$24,000
$19,499
$22,080
$30,045
$14,917
$135,866
$3,212,541
$20,192
$100,247
$145,008
$24,718
$31,498
$131,659
$19,277
$153,181
$49,965
$328,031
$151,358
$1,043
$117,614

Source: Dignity Health

39



Bruceville Enrollment Assistance: Provides assistance to low income patients to enroll in
government sponsored health insurance programs including Medi-Cal;



Cancer Focused Nurse Navigator: Coordinates patient/doctor communication following
abnormalities discovered in mammograms, breast ultrasounds, or breast MRIs and
provides information to the community about financial assistance for breast cancer
screening;



Charity Prescriptions: Donation of prescription medications to uninsured and
underserved patients;



El Hogar Refer Net: In collaboration with the community based nonprofit mental health
provider, El Hogar, this program provides a process for patients admitted to the
emergency department with mental illness to receive immediate and ongoing treatment
and other social services they need after leaving the Hospital;

 40



Chronic Disease Self-Management Program: The program offers weekly workshops for
six weeks on diabetes in clinical and community settings as well as on other chronic
health problems;



Lutheran Social Services Homeless Housing: This program partners hospital care
coordinators with Lutheran Social Services staff to identify and evaluate chronically
homeless, high end hospital users and place them in transitional housing units;



Patient Navigation Program: In partnership with Sacramento Covered and Health Net,
this program assists underserved patients who are admitted to the emergency
department for non-urgent care by connecting with a primary care Provider, community
clinics, and other social support services;



Sacramento Community Partnerships: A collaboration with other regional health
providers and community based nonprofit organizations to address specific priorities
identified in the Community Needs Assessment and unmet healthcare needs;



Transportation – Poor: Providers taxi or other transportation services to the poor;



Wellspace Interim Care Program: A collaboration between other Dignity Health hospitals
and health systems in the region, Sacramento County, and Federally Qualified Health
Center, WellSpace Health, to provide shelter and treatment for homeless patients with
physical or mental health disorders. The program also provides case management
services to connect participants with outpatient services and community resources;



Counseling Service – Poor: Psychiatric consults for patients who are uninsured and
require psychiatric medical evaluations while hospitalized and conservatorship services
to low-income patients who may lack capacity or family to help make decisions;



Mercy Family Health Center (Family Practice Residency): Resident physicians are
sponsored by the hospital to provide primary health care services to the poor and
underinsured at the Mercy Family Health Center located on the campus of Methodist
Hospital;



Renal Dialysis Services: The Care Coordination Department pays for dialysis services for
the underserved;

 41



Cash– In Kind Donations – Poor: Cash and in-kind donations by the hospital to nonprofit
community-based organizations that provide health related services for the
underinsured, uninsured, and vulnerable populations in the community;



Dignity Health Community Grants: Funding from the Hospital awarded to nonprofit
organizations working to improve the health and well-being of vulnerable and
underserved populations and reduce disparities in the community;



In Kind Donation – Equipment/Supplies: Provides medical supplies and other
equipment, such as wheelchairs for those who cannot afford to rent or purchase these
items;



Transitional Housing and Lodging – Poor: Provides payment for short-term room and
board in the community for patients unable to pay this expense after they are
discharged from the hospital;



Community Benefit Assigned Staff: A dedicated Community Health and Outreach team
that oversees community health and outreach activities and reporting for all
Sacramento region hospitals, develops the Sacramento Service Area Community Needs
Assessment, and develops strategic partnerships working collaboratively with other
health providers and community based organizations to focus on disproportionate
unmet needs;



Mercy Faith & Health Partnership: A community outreach program that encourages,
supports and nurtures local faith communities to develop and sustain health ministry
programs that advocate health promotion and disease prevention in their communities;



Mercy Heart & Vascular Institute – Cardiovascular Disease Management: This program
runs CHAMP (Congestive Heart Active Management Program) that provides patients
with phone interventions, educational classes, and disease management skills after they
are discharged from the Hospital;



Professional & Medical Education – Other: Education for medical students, physicians,
nurses, and other healthcare professionals. This includes Hospital staff serving as
preceptors to students;



Professional & Medical Education – Medical Students: Provides seminars and training
for physicians and other medical students. This includes Hospital staff serving as
preceptors to students;

 42



Professional & Medical Education – Nursing: Seminars and training for nurses focused
on the health of the broader community. This includes Hospital staff serving as
preceptors to students;



Cash and in Kind Donations – Broader: The Hospital sponsors and participates in
community health or health related events and activities that benefit all in the
community; and



Mercy Foundation – A nonprofit organization raising philanthropic support and
community awareness for the works of the Sisters of Mercy in healthcare, education,
housing for the homeless, and care for the poor and elderly.

 Reproductive Health
For CY 2016, Methodist Hospital of Sacramento reported 71 inpatient discharges related to
reproductive health services26. The following table lists reproductive services by diagnostic
related group discharges (DRG) for CY 2016.
METHODIST HOSPITAL OF SACRAMENTO
CY 2016 REPRODUCTIVE SERVICE BY DIAGNOSTIC RELATED GROUP
Discharges
767-Vaginal Delivery W Sterilization &/Or D&C1
41
778-Threatened Abortion
14
777-Ectopic Pregnancy
12
770-Abortion W D&C1, Aspiration Curettage Or Hysteroctomy
3
1
779-Abortion W/O D&C
1
Total Discharges:
71
Source: CY 2016 OSHPD Patient Discharge Database
1
D&C is an abbreviation for Dilation and Curettage



Out of the five diagnostic related groups, DRG 767- Vaginal Delivery with Sterilization
has the highest number of reproductive service inpatient discharges.

The following table indicates whether the Hospital performs the following women’s
reproductive services.
METHODIST HOSPITAL OF SACRAMENTO
REPRODUCTIVE SERVICES
Procedure
Caesarean delivery with sterilization
Terminate pregnancy when:
A. Placenta previa
B. Premature rupture of membranes
C. Second trimester bleeding with previable fetus
Placement of an IUD at time of other gynecological surgery
Postpartum placement of IUD
Gender affirming surgery
Emergency contraception as emergency room or inpatient service
Ectopic pregnancy treatment with methotrexate (medication in lieu of surgery)
Source: Dignity Health

26

Methodist Hospital of Sacramento is not a Catholic hospital and is not subject to the Catholic ERDs.

43

Currently Performed?
(Y/N)
Yes
No
No
No
No
No
No
No
No

 Analysis of Methodist Hospital of Sacramento
Service Area Definition
Methodist Hospital of Sacramento’s service area is comprised of 23 ZIP Codes from which 78%
of its inpatient discharges originated in CY 2016. Approximately 50% of the Hospital’s
discharges originated from the top five ZIP Codes, all of which are in the Cities of Sacramento
and Elk Grove. In CY 2016, the Hospital’s market share in the service area was 15.5%.

ZIP Codes Community
95823
Sacramento
95828
Sacramento
95624
Elk Grove
95758
Elk Grove
95822
Sacramento
95824
Sacramento
95757
Elk Grove
95829
Sacramento
95632
Galt
95831
Sacramento
95820
Sacramento
95832
Sacramento
95826
Sacramento
95693
Wilton
95817
Sacramento
95827
Sacramento
95638
Herald
95612
Clarksburg
95615
Courtland
95639
Hood
95655
Mather
95830
Sacramento
95759
Elk Grove
Subtotal
Other ZIPs
Total Discharges

METHODIST HOSPITAL OF SACRAMENTO
PATIENT ORIGIN CY 2016
Total
% of Cumulative %
Discharges Discharges of Discharges
2,030
18.4%
18.4%
1,283
11.6%
30.0%
918
8.3%
38.3%
773
7.0%
45.3%
719
6.5%
51.8%
562
5.1%
56.9%
484
4.4%
61.3%
340
3.1%
64.3%
324
2.9%
67.3%
284
2.6%
69.8%
273
2.5%
72.3%
263
2.4%
74.7%
122
1.1%
75.8%
77
0.7%
76.5%
63
0.6%
77.1%
55
0.5%
77.6%
31
0.3%
77.8%
14
0.1%
78.0%
13
0.1%
78.1%
11
0.1%
78.2%
9
0.1%
78.3%
8
0.1%
78.3%
7
0.1%
78.4%
8,663
78.4%
78.4%
2,386
21.6%
100%
11,049
100%

Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

44

Total Area
Discharges
8,524
5,823
4,638
4,321
4,744
3,340
2,742
2,001
2,558
3,349
4,267
1,205
3,195
507
1,705
2,093
213
116
54
43
280
92
63
55,873

Market
Share
23.8%
22.0%
19.8%
17.9%
15.2%
16.8%
17.7%
17.0%
12.7%
8.5%
6.4%
21.8%
3.8%
15.2%
3.7%
2.6%
14.6%
12.1%
24.1%
25.6%
3.2%
8.7%
11.1%
15.5%

 Service Area Map
Methodist Hospital of Sacramento’s service area has approximately 1.5 million residents. There
are four other hospitals located within the Hospital’s service area: Sierra Vista Hospital, Kaiser
Foundation Hospital South Sacramento and University of California Davis Medical Center. There
are ten other hospitals located within approximately 10 miles from Methodist Hospital of
Sacramento. Methodist Hospital of Sacramento is the third-largest inpatient market share
leader in the service area.

45

 Hospital Market Share
The table below provides the market share of inpatient discharges by individual hospital within
Methodist Hospital of Sacramento’s service area from CY 2013 to CY 2016.
METHODIST HOSPITAL OF SACRAMENTO
MARKET SHARE BY HOSPITAL CY 2013 - CY 2016
Hospital
CY 2013 CY 2014 CY 2015 CY 2016 Trend
Kaiser Foundation Hospital - South Sacramento
18.4%
19.2%
19.4%
20.3%
↗
Sutter Medical Center, Sacramento
10.8%
10.0%
10.3%
17.1%
↗
Methodist Hospital of Sacramento
16.0%
16.8%
17.2%
15.5%
↘
UC Davis Medical Center
16.1%
15.7%
14.9%
15.0%
↘
Mercy General Hospital
10.3%
10.1%
9.3%
8.7%
↘
Kaiser Foundation Hospital - Roseville
2.5%
2.6%
3.0%
3.1%
↗
Kaiser Foundation Hospital - Sacramento
2.5%
2.4%
2.6%
2.9%
↗
Sierra Vista Hospital
2.8%
2.7%
2.9%
2.9%
→
Mercy San Juan Medical Center
2.8%
2.9%
2.6%
2.4%
↘
Heritage Oaks Hospital
1.0%
1.3%
1.5%
1.4%
→
Adventist Health Lodi Memorial
1.2%
1.4%
1.4%
1.4%
→
Sutter Center For Psychiatry
0.9%
1.0%
1.0%
1.0%
→
Sutter Roseville Medical Center
0.7%
0.8%
0.7%
0.8%
→
Mercy Hospital of Folsom
0.4%
0.5%
0.6%
0.7%
↗
Woodland Memorial Hospital
0.2%
0.3%
0.4%
0.5%
↗
UCSF Medical Center
0.4%
0.4%
0.4%
0.5%
→
Fremont Hospital
0.1%
0.0%
0.2%
0.4%
↗
Sacramento Mental Health Treatment Center
0.9%
0.4%
0.3%
0.4%
→
Crestwood Psychiatric Health Facility-Sacramento
0.5%
0.4%
0.4%
0.3%
↘
St. Joseph's Behavioral Health Center
0.4%
0.5%
0.5%
0.3%
↘
Crestwood Psychiatric Health Facility-Carmichael
0.6%
0.4%
0.3%
0.3%
↘
All Other
10.4%
10.3%
10.3%
4.3%
↘
Total Percentage
100%
100%
100%
100%
Total Discharges
55,953 55,569 55,606 55,873
→
Source: OSHPD Discharge Database CY 2013 - CY 2016
Note: Excludes normal newborns

46



The number of discharges (55,873) in Methodist Hospital of Sacramento’s service area
has remained relatively constant CY 2013 and CY 2016;



From CY 2013 to CY 2016, Kaiser Foundation Hospital - South Sacramento consistently
ranked first in terms of overall market share based on inpatient discharges (20.3% in CY
2016); and



Methodist Hospital of Sacramento ranked among the top three market share leaders
based on inpatient discharges between CY 2013 and CY 2016.

 Market Share by Payer Type
The following table illustrates the service area’s hospital market share by payer type as
reported by OSHPD for CY 2016.

14.5%
18.5%
12.2%
10.0%
3.3%
15.0%
8,364

12.6%
7.9%
5.3%
4.6%
2.6%
8.7%
4,837

0.6%
2.0%
7.6%
0.6%
3.2%
3.1%
1,729

4.6%
1.1%
3.2%
0.6%
3.5%
2.9%
1,637

Sierra Vista Hospital

18.5%
19.8%
7.7%
7.0%
10.8%
15.5%
8,663

Kaiser Foundation
Hospital Sacramento

14.9%
19.7%
15.6%
25.3%
26.9%
17.1%
9,546

Kaiser Foundation
Hospital –
Roseville

21.6%
12.0%
29.8%
3.3%
27.1%
20.3%
11,324

Mercy General Hospital

University Of California
Davis
Medical Center

55,873

Methodist Hospital Of
Sacramento

Total
Discharges
19,622
18,452
15,716
1,544
539

Sutter Medical Center
Sacramento

Payer Type
Medicare
Medi-Cal
Private Coverage
All Other
Self-Pay
Total Percentage
Total Discharges

Kaiser Foundation
Hospital - South
Sacramento

METHODIST HOSPITAL OF SACRAMENTO
HOSPITAL MARKET SHARE BY PAYER TYPE CY 2016

0.9%
3.8%
4.3%
3.0%
0.2%
2.9%
1,617

All
Others
11.7%
15.1%
14.3%
45.6%
22.4%
14.6%
8,156

Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

47



The largest payer category of service area inpatient discharges is Medicare with 19,622
discharges (35%), Medi-Cal with 18,452 discharges (33%), and Private Coverage with
15,716 discharges (28%);



Kaiser Foundation Hospital – South Sacramento is the market share leader for Medicare
(22%), Private Coverage (30%) and Self-Pay (27%); and



Methodist Hospital of Sacramento is the market share leader for Medi-Cal (20%).

Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%

 Market Share by Service Line
The following table provides the service area’s inpatient market share for CY 2016.

48

Sutter Medical Center, Sacramento

Methodist Hospital Of Sacramento

University Of California Davis Medical Center

Mercy General Hospital

Kaiser Foundation Hospital - Roseville

Kaiser Foundation Hospital - Sacramento

Sierra Vista Hospital

Total
Service Line
Discharges
General Medicine
16,128
Obstetrics
8,779
Cardiac Services
5,352
Behavioral Health
4,987
General Surgery
4,797
Orthopedics
3,740
Neonatology
3,324
Neurology
2,223
Oncology/Hematology (Medical)
1,466
Other
879
Spine
790
Vascular Services
643
Gynecology
598
Urology
539
ENT
525
Rehabilitation
513
Neurosurgery
429
No-match-found
97
Total Percentage
Total Discharges
55,873
Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

Kaiser Foundation Hospital - South
Sacramento

METHODIST HOSPITAL OF SACRAMENTO
HOSPITAL MARKET SHARE BY SERVICE LINE CY 2016

20.3%
26.6%
20.1%
1.2%
23.5%
27.8%
34.2%
14.3%
11.9%
27.4%
8.2%
16.3%
10.4%
24.5%
23.8%
0.0%
7.9%
14.4%
20.3%
11,324

15.5%
33.5%
14.9%
0.8%
13.9%
14.0%
23.3%
16.9%
15.5%
10.5%
18.5%
22.9%
15.1%
17.1%
12.4%
0.0%
11.9%
9.3%
17.1%
9,546

21.4%
14.1%
14.6%
1.4%
15.6%
14.7%
12.2%
21.4%
11.1%
5.5%
3.5%
8.7%
26.3%
10.4%
5.5%
75.6%
0.5%
6.2%
15.5%
8,663

19.5%
6.3%
16.5%
1.7%
19.4%
14.4%
8.5%
17.8%
32.6%
31.9%
21.1%
18.2%
12.7%
18.0%
33.5%
2.5%
22.1%
26.8%
15.0%
8,364

8.4%
5.5%
22.6%
0.6%
9.4%
9.2%
2.4%
7.9%
10.4%
2.5%
14.3%
14.5%
14.9%
10.9%
6.9%
20.1%
4.9%
9.3%
8.7%
4,837

1.6%
8.0%
0.9%
0.0%
1.2%
1.2%
12.8%
1.3%
5.9%
1.6%
1.3%
0.9%
0.7%
1.9%
4.6%
0.0%
3.5%
1.0%
3.1%
1,729

3.4%
0.0%
2.6%
0.4%
4.2%
5.9%
0.0%
6.2%
2.9%
1.9%
14.6%
3.0%
6.2%
1.9%
1.5%
0.0%
25.6%
5.2%
2.9%
1,637

0.0%
0.0%
0.0%
32.3%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
2.9%
1,617

All
Others
9.9%
6.0%
7.8%
61.4%
12.8%
12.9%
6.6%
14.2%
9.8%
18.8%
18.5%
15.6%
13.9%
15.4%
11.8%
1.8%
23.5%
27.8%
14.6%
8,156

Total
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%



Methodist Hospital of Sacramento is the service line leader in four of 18 service lines:
neurology (21%), general medicine (21%), gynecology (26%), and rehabilitation (76%);



University of California, Davis Medical Center is the service area inpatient service line
leader in four of 18 service lines: urology (34%), oncology/hematology (33%), other
(32%), and spine (21%); and



Kaiser Foundation Hospital – South Sacramento is the service area leader in four of 18
service lines: general surgery (24%), orthopedics (28%), neonatology (34%), and urology
(25%).

 Market Share by ZIP Code
The following table illustrates the service area’s hospital market share by ZIP Code for CY 2016.

Kaiser Foundation Hospital - Sacramento

Sierra Vista Hospital

55,873

Kaiser Foundation Hospital - Roseville

8,524
5,823
4,744
4,638
4,321
4,267
3,349
3,340
3,195
2,742
2,558
2,093
2,001
1,705
1,205
507
280
213
116
92
63
54
43

Mercy General Hospital

Sacramento
Sacramento
Sacramento
Elk Grove
Elk Grove
Sacramento
Sacramento
Sacramento
Sacramento
Elk Grove
Galt
Sacramento
Sacramento
Sacramento
Sacramento
Wilton
Mather
Herald
Clarksburg
Sacramento
Elk Grove
Courtland
Hood

University Of California Davis Medical
Center

95823
95828
95822
95624
95758
95820
95831
95824
95826
95757
95632
95827
95829
95817
95832
95693
95655
95638
95612
95830
95759
95615
95639
Total Percentage
Total Discharges

Total
Discharges

Methodist Hospital Of Sacramento

Community

Sutter Medical Center, Sacramento

ZIP Code

Kaiser Foundation Hospital - South
Sacramento

METHODIST HOSPITAL OF SACRAMENTO
HOSPITAL MARKET SHARE BY ZIP CODE CY 2016

All
Others

22.1%
24.1%
19.8%
29.5%
28.1%
12.1%
21.4%
13.7%
4.1%
29.6%
22.0%
3.2%
27.6%
8.3%
20.4%
27.8%
5.7%
25.4%
22.4%
23.9%
38.1%
27.8%
23.3%
20.3%
11,323

14.8%
14.4%
20.0%
16.6%
18.1%
16.8%
25.9%
19.0%
18.9%
18.5%
9.6%
16.0%
14.9%
18.1%
17.7%
15.2%
12.1%
9.9%
26.7%
29.3%
11.1%
18.5%
18.6%
17.1%
9,546

23.8%
22.0%
15.2%
19.8%
17.9%
6.4%
8.5%
16.8%
3.8%
17.7%
12.7%
2.6%
17.0%
3.7%
21.8%
15.2%
3.2%
14.6%
12.1%
8.7%
11.1%
24.1%
25.6%
15.5%
8,663

11.3%
11.7%
15.2%
10.3%
10.0%
29.7%
14.8%
23.0%
17.2%
10.1%
7.8%
18.8%
12.2%
33.7%
15.2%
12.2%
13.6%
8.9%
6.9%
5.4%
0.0%
11.1%
11.6%
15.0%
8,364

7.4%
7.6%
11.6%
6.2%
7.3%
11.3%
11.2%
10.9%
13.2%
5.8%
4.2%
12.2%
5.7%
10.4%
6.0%
5.1%
5.0%
6.1%
7.8%
4.3%
4.8%
1.9%
7.0%
8.7%
4,837

2.0%
2.3%
2.3%
2.8%
3.1%
3.0%
3.3%
1.3%
8.3%
3.0%
1.4%
7.9%
3.7%
2.8%
2.6%
1.0%
19.6%
0.9%
1.7%
6.5%
4.8%
0.0%
0.0%
3.1%
1,729

1.4%
2.1%
1.7%
2.1%
1.9%
2.5%
1.8%
1.1%
14.8%
1.5%
0.6%
12.0%
1.7%
2.4%
1.7%
2.4%
11.1%
0.9%
0.0%
5.4%
3.2%
0.0%
0.0%
2.9%
1,637

4.6%
3.0%
3.0%
1.9%
2.3%
3.4%
1.7%
2.9%
2.9%
2.2%
1.8%
2.1%
2.4%
4.5%
2.1%
3.4%
4.6%
0.5%
0.9%
3.3%
0.0%
0.0%
4.7%
2.9%
1,617

12.6%
12.7%
11.2%
10.8%
11.4%
14.8%
11.5%
11.3%
16.7%
11.6%
40.0%
25.3%
14.6%
16.2%
12.5%
17.8%
25.0%
32.9%
21.6%
13.0%
27.0%
16.7%
9.3%
14.6%
8,157

Total

100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%

Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

49



Methodist Hospital of Sacramento is the inpatient market share leader in three of the 23
ZIP Codes, all of which are in within the Cities of Sacramento and Hood;



Kaiser Foundation Hospital South Sacramento is the inpatient market share leader in ten
of the 23 ZIP Codes in the Cities of Sacramento, Elk Grove, Galt, Wilton, Herald, and
Courtland; and



Sutter Medical Center Sacramento is also the inpatient market share leader in a
different five ZIP Codes in the Cities of Sacramento and Clarksburg.

 Profile of Mercy San Juan Medical Center
Overview
Mercy San Juan Medical Center is general acute care hospital located on 6501 Coyle Avenue in
Carmichael, California. The Hospital was established in 1967 as Mercy San Juan Hospital before
being renamed Mercy San Juan Medical Center in 2001.
Today, Mercy San Juan Medical Center offers a range of services including: a Level II Trauma
Center, a Primary Stroke Center, and critical care medicine. The Hospital has 16 surgical
operating rooms and a “basic” emergency department with 31 emergency treatment stations.
According to Mercy San Juan Medical Center’s current hospital license, it is licensed for 370
beds as shown below.

MERCY SAN JUAN MEDICAL CENTER
LICENSED BED DISTRIBUTION 2018
Licensed Bed Type
Number of Beds1
General Acute Care Beds
Neonatal Intensive Care
26
Perinatal
32
Intensive Care
45
Pediatric
8
Coronary Care
11
Unspecified General Acute Care
248
Total General Acute Care Beds
370
Total Licensed Beds
370
1

50

2018 Hospital License

 Key Statistics
For FY 2017, San Juan Medical Center reported 20,298 inpatient discharges, 95,314 patient
days, and an average daily census of 261 patients (approximately 71% occupancy).
MERCY SAN JUAN MEDICAL CENTER
KEY STATISTICS FY 2015 - FY 20171
FY 2015
Inpatient Discharges
25,036
Licensed Beds
370
Patient Days
107,793
Average Daily Census
295
Occupancy
79.8%
Average Length of Stay
4.3
Cardiac Catheterization Procedures
3,122
Emergency Service Visits
119,478
Total Live Births
2,082

FY 2016
21,097
370
103,767
284
76.8%
4.9
3,162
77,124
2,001

FY 2017
20,298
370
95,314
261
70.6%
4.7
3,444
74,867
1,858

Sources: OSHPD Disclosure Reports, FY 2015 - FY 2017
1
FY 2015 and FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 data is from unaudited.

51



Since FY 2015, inpatient discharges have significantly decreased by 19%;



In FY 2017, 74,867 emergency service visits were reported, a 36% decrease from FY
2015;



In FY 2017, there were 3,444 cardiac catheterization procedures reported; and



Between FY 2015 and FY 2017, total live births have remained relatively constant, with
an average of 1,980 live births annually.

 Patient Utilization Trends
The following table shows FY 2013 – FY 2017 volume trends at Mercy San Juan Medical Center.
MERCY SAN JUAN MEDICAL CENTER*
SERVICE VOLUMES FY 2013 - FY 20171
FY 2013
FY 2014
63,144
71,747
8,651
8,919
13,256
15,722
6,672
7,018
2,195
1,916
93,918
105,322

PATIENT DAYS
FY 2015
FY 2016
Medical/Surgical
74,195
71,610
Neonatal Intensive Care
8,504
8,719
Intensive Care
17,351
16,146
Obstetrics
6,134
6,018
Pediatrics Acute
1,609
1,274
Total
107,793
103,767
DISCHARGES
Medical/Surgical
14,383
17,880
18,217
16,554
Neonatal Intensive Care
59
506
378
342
Intensive Care
927
1,413
1,982
2,117
Obstetrics
1,526
4,065
3,639
1,544
Pediatrics Acute
887
1,019
820
540
Total
17,782
24,883
25,036
21,097
AVERAGE LENGTH OF STAY
Medical/Surgical2
4.4
4.0
4.1
4.3
Neonatal Intensive Care
146.6
17.6
22.5
25.5
Intensive Care
14.3
11.1
8.8
7.6
Obstetrics
4.4
1.7
1.7
3.9
Pediatrics Acute
2.5
1.9
2.0
2.4
Total
5.3
4.2
4.3
4.9
AVERAGE DAILY CENSUS
Medical/Surgical2
173.0
196.6
203.3
196.2
Neonatal Intensive Care
23.7
24.4
23.3
23.9
Intensive Care
36.3
43.1
47.5
44.2
Obstetrics
18.3
19.2
16.8
16.5
Pediatrics Acute
6.0
5.2
4.4
3.5
Total
257
289
295
284
OTHER SERVICES
Inpatient Surgeries
4,681
4,765
4,441
4,764
Outpatient Surgeries
5,969
5,860
5,399
5,583
Emergency Services Visits
70,530
73,377
119,478
77,124
Total Live Births
2,149
2,148
2,082
2,001
Sources: OSHPD Disclosure Reports, FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.
2
Includes Definitive Observation Beds
*The Hospital noted that service volumes for FY 2013 were misreported to OSHPD.

FY 2017
65,958
7,604
14,859
5,686
1,207
95,314
14,743
361
1,258
3,260
676
20,298
4.5
21.1
11.8
1.7
1.8
4.7
180.7
20.8
40.7
15.6
3.3
261
4,634
5,975
74,867
1,858

A review of Mercy San Juan Medical Center’s historical utilization trends between FY 2013 and
FY 2017 supports the following conclusions:

52



Total patient days have increased by 2%;



Inpatient discharges have increased by 14%;



The average daily census has fluctuated with a 4% decrease from 295 patients in FY
2015 to 284 patients in FY 2016, followed by an 8% decrease in FY 2017; and



Emergency service visits have increased by 6%.

 Financial Profile
Over the last five fiscal years, Mercy San Juan Medical Center has had a positive net income
ranging from $22.4 million in FY 2013 to $29.8 million in FY 2016, followed by a loss of $7.8
million in FY 2017. Between FY 2013 and FY 2017, net patient revenue and total operating
revenue increased by nearly 16% and 15% respectively. Over the same period, the Hospital’s
operating expenses increased by approximately 21% from $512.4 million in FY 2013 to $621.2
million in FY 2017. Other operating revenue decreased significantly over the five-year period by
55% from $4.6 million to $2.1 million.
The Hospital’s current-ratio has fluctuated over the last five years but decreased from 4.38 in FY
2013 to 3.74 in FY 2017. The California average in FY 2016 was 1.56. The Hospital’s percentage
of bad debt is 0.6% and lower than the state average of 0.8%.
MERCY SAN JUAN MEDICAL CENTER
FINANCIAL AND RATIO ANALYSIS FY 2013 - FY 2017
Patient Days
Discharges
ALOS
Net Patient Revenue
Other Operating Revenue
Total Operating Revenue
Operating Expenses
Net from Operations
Net Non-Operating Revenues and
Expenses
Net Income

FY 2013
93,918
17,782
5.3

FY 2014
105,322
24,883
4.2

FY 2015
107,793
25,036
4.3

FY 2016
103,767
21,097
4.9

FY 20171
95,314
20,298
4.7

-

$519,522,002
$4,646,115
$524,168,117
$512,405,807
$11,762,310

$547,547,245
$3,976,893
$551,524,138
$529,464,186
$22,059,952

$651,021,293
$3,186,591
$654,207,884
$610,703,683
$43,504,201

$651,159,682
$4,448,794
$655,608,476
$623,733,661
$31,874,815

$602,906,591
$2,080,830
$604,987,421
$621,216,571
($16,229,150)

-

$10,607,602

$13,308,048

$3,682,799

($2,061,506)

$8,414,173

-

$22,369,912

$35,368,000

$47,187,000

$29,813,309

($7,814,977)

Current Ratio
4.38
4.78
4.04
3.69
Days in A/R
49.4
58.3
46.2
50.8
Bad Debt Rate
3.8%
2.8%
1.7%
1.0%
Operating Margin
2.24%
4.00%
6.65%
4.86%
Source: OSHPD Disclosure Reports, FY 2013 - FY 2017
1 1 FY 2015 and FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 data is from unaudited
2 FY 2017 California data was not available when the data was collected to prepare this report

3.74
46.7
0.6%
-2.68%

2016
California
Average2
1.56
57.1
0.8%
2.74%

53

 Cost of Hospital Services
Mercy San Juan Medical Center’s operating cost of services includes both inpatient and
outpatient care. In FY 2017, 43% of total costs were associated with Medicare, followed by 34%
with Medi-Cal and 21% with Third-Party.

Operating Expenses
Cost of Services By Payer:
Medicare
Medi-Cal
County Indigent
Third-Party
Other Indigent
All Other Payers

MERCY SAN JUAN MEDICAL CENTER
OPERATING EXPENSES BY PAYER CATEGORY FY 2013 - FY 20171
FY 2013
FY 2014
FY 2015
FY 2016
$512,405,807
$529,464,186
$610,703,683
$623,733,661

$211,877,689
$127,818,079
$24,002,924
$122,668,538
$6,584,829
$19,453,747

$220,109,065
$147,865,311
$16,798,111
$118,960,681
$2,827,059
$22,903,959

$255,543,323
$207,252,514
$513,212
$134,077,295
$3,056,034
$10,261,304

$262,385,507
$222,122,018
$21,507
$130,546,924
$2,327,657
$6,330,048

FY 2017
$621,216,571

$267,806,107
$213,924,147
$3,684
$130,437,706
$3,236,664
$5,808,264

Source: OSHPD Disclosure Reports, FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.

Charity Care
The following table shows a comparison of charity care and bad debt for Mercy San Juan
Medical Center and all general acute care hospitals in the State of California. The five-year (FY
2013 – FY 2017) average of charity care and bad debt, as a percentage of gross patient revenue,
was 2.9% and higher than the four-year statewide average of 2.5%. According to OSHPD, “…the
determination of what is classified as charity care can be made by establishing whether or not
the patient has the ability to pay. The patient’s accounts receivable must be written off as bad
debt if the patient has the ability but is unwilling to pay off the account.”
MERCY SAN JUAN MEDICAL CENTER
CHARITY CARE COMPARISON FY 2013 - FY 20171 (In Thousands)
FY 2013
FY 2014
FY 2015
Hospital
CA
Hospital
CA
Hospital
CA
$2,194,488
$320,382,471
$2,493,449
$338,322,364
$2,683,517
$365,501,463
$43,499
$6,563,487
$20,842
$5,113,965
$20,066
$3,441,227
$82,346
$5,891,632
$69,503
$4,365,936
$45,635
$3,262,642
$125,844
$12,455,119
$90,345
$9,479,902
$65,700
$6,703,869
2.0%
2.0%
0.8%
1.5%
0.7%
0.9%
3.8%
1.8%
2.8%
1.3%
1.7%
0.9%
5.7%
3.9%
3.6%
2.8%
2.4%
1.8%

Gross Patient Revenue
Charity
Bad Debt
Total Charity & Bad Debt
Charity Care as a % of Gross Patient Revenue
Bad Debt as a % of Gross Patient Revenue
Total as a % of Gross Patient Revenue
Uncompensated Care
Cost to Charge Ratio
23.1%
24.5%
21.1%
23.6%
Charity
$10,065
$1,608,711
$4,392
$1,207,919
Bad Debt
$19,053
$1,444,039
$14,648
$1,031,234
Total
$29,118
$3,052,750
$19,040
$2,239,153
Source: OSHPD Disclosure Reports FY 2013 - FY 2017
1
FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 data is from unaudited.
2
FY 2017 California data was not available when the data was collected to prepare this report.

54

22.6%
$4,543
$10,331
$14,874

24.1%
$828,647
$785,644
$1,614,292

FY 2016
Hospital
CA
$2,793,538
$396,427,743
$21,202
$3,457,868
$27,712
$3,108,971
$48,914
$6,566,839
0.8%
0.9%
1.0%
0.8%
1.8%
1.7%
22.2%
$4,700
$6,143
$10,843

23.8%
$822,627
$739,624
$1,562,251

FY 2017
Hospital
CA 2
$2,759,313
$17,065
$15,748
$32,813
0.6%
0.6%
1.2%
22.4%
$3,829
$3,533
$7,363

-

 The following table shows the Hospital’s historical costs for charity care as reported to OSHPD.
Charity care costs have decreased from $10.1 million in FY 2013 to $3.8 million in FY 2017. The
average cost of charity care for the last five-year periods was $5.5 million, while the three-year
average cost of charity care was $4.4 million.
MERCY SAN JUAN MEDICAL CENTER
COST OF CHARITY CARE FY 2013 - FY 20171
Cost to
Charity Care
Charge
Year
Charges
Ratio
FY 2017
$17,065,302
22.4%
FY 2016
$21,201,778
22.2%
FY 2015
$20,065,782
22.6%
FY 2014
$20,842,000
21.1%
FY 2013
$43,498,551
23.1%
FY 2015 - FY 2017 Average
FY 2013 - FY 2017 Average

Cost of Charity
Care to the
Hospital
$3,829,119
$4,700,112
$4,542,660
$4,392,393
$10,064,678
$4,357,297
$5,505,792

Source: OSHPD Disclosure Reports FY 2013 - FY 2017
1
FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.

In the application to the California Attorney General, Dignity Health reported the following
combined distribution of charity care costs by inpatient, outpatient, and emergency room costs
in the table below.
MERCY SAN JUAN MEDICAL CENTER
COST OF CHARITY CARE BY SERVICE FY 2013 - FY 2017
Emergency
Inpatient
Outpatient
Room
FY 2017:
Cost of Charity
Visits/Discharges
FY 2016:
Cost of Charity
Visits/Discharges
FY 2015:
Cost of Charity
Visits/Discharges
FY 2014:
Cost of Charity
Visits/Discharges
FY 2013:
Cost of Charity
Visits/Discharges

Total Costs

$1,613,256
75

$1,084,145
388

$698,613
828

$3,396,014

$1,932,078
106

$608,859
253

$426,967
526

$2,967,904

$3,764,343
232

$844,810
381

$530,159
793

$5,139,312

$2,831,491
177

$620,206
298

$408,847
553

$3,860,544

$3,970,611
258

$738,095
372

$448,457
649

$5,157,163

Source: Dignity Health

Note that these totals are different than what Dignity Health reported to OSHPD. However,
after discussion with JD Healthcare Inc. and Vizient Inc., Dignity Health has acknowledged that
an error was made in its calculation of charity care costs. Dignity Health has stated that they
will comply with the charity care cost amounts determined in the manner described above.

55

 Community Benefit Services
In the last five years, Mercy San Juan Medical Center has spent a significant amount on
community benefit services. As shown in the table below, the average annual cost of
community benefit services over the last three years has been $5.7 million. The average annual
cost of community benefit services over the last five years has been $5.3 million.
MERCY SAN JUAN MEDICAL CENTER
COMMUNITY BENEFIT SERVICES FY 2013 - FY 2017
Community Benefit Programs
Benefits for Living in Poverty
Benefits for Broader Community
Totals
Medi-Cal Provider Fee CHFT Grant Expense
Adjusted Totals
Source: Dignity Health

FY 2013
$6,931,808
$378,754
$7,310,562
($1,594,082)
$5,716,480

FY 2014
$3,950,809
$311,099
$4,261,908
($601,567)
$3,660,341

FY 2015
$4,628,475
$4,869,421
$9,497,896
($1,781,133)
$7,716,763

FY 2016
$3,577,459
$2,512,761
$6,090,220
($667,929)
$5,422,291

FY 2017
$3,161,175
$1,426,737
$4,587,912
($660,144)
$3,927,768

FY 2015 – FY 2017 Average
$3,789,036
$2,936,306
$6,725,343
$5,688,941

FY 2013 – FY 2017 Average
$4,449,945
$1,899,754
$6,349,700
$5,288,729

● The Hospital’s five-year average cost of community benefit services for persons living in
poverty is $4.4 million per year;
● The Hospital’s five-year average cost of community benefit services for the broader
community is $1.9 million per year; and
● Over the five-year period, the Hospital’s adjusted total cost of community benefit
services decreased from $5.7 million in FY 2013 to $3.9 million in FY 2017.
The Hospital’s community benefit services over the past five fiscal years included the following
programs over $10,000 in cost in FY 2017:

56

 MERCY SAN JUAN MEDICAL CENTER
COST OF COMMUNITY BENEFIT SERVICES FY 2013 - FY 2017
Services over $10,000 in cost in FY 2017:
Catholic School Health Nurse
Chronic Disease Self-Management Program
El Hogar Refer Net
Lutheran Social Services Homeless Housing
Patient Navigator Program
Sacramento Community Partnerships
Safe Kids Car Seat Classes and Health/Safety
Education
Wellspace Interim Care Program
Counseling Service-Poor
Emergency and Trauma Services (Ambulance
Services)
Mercy Family Health Center (Family Practice
Residency)
Renal Dialysis Services
Cash-In Kind Donations-Poor
Dignity Health Community Grants
Sacramento Service Area
Partnerships/Donations-Poor
Transitional Housing and Lodging -Poor
Community Benefit Assigned Staff
Mercy Faith & Health Partnership
Mercy Heart & Vascular Institute Cardiovascular Disease Management
Professional & Medical Education - Nursing
Professional & Medical Education - Other
Mercy Foundation Support

FY 2013
$18,071
$28,194
-

FY 2014
$19,880
$16,639
$127,128
-

FY 2015
$22,074
$20,030
$156,256
$57,451

FY 2016
$18,070
$17,376
$76,990
$145,351

FY 2017
$16,838
$24,713
$43,803
$57,000
$16,968
$52,440

$438,161
$668,402

$215,705
$1,075,909

$133,260
$663,590

$202,998
$829,054

$317,221
$35,428
$470,909

-

-

-

-

$104,200

$124,606
$33,501
$274,417

$184,393
$31,893
$282,686

$244,902
$145,096
$257,573

$248,552
$56,015
$265,399

$243,230
$65,523
$81,425
$305,987

$766,569
$1,967
$110,744
$24,708

$429,267
$4,901
$106,841
$33,969

$356,802
$3,538
$112,135
$33,472

$53,725
$118,314
$35,252

$13,300
$515,725
$116,577
$38,641

-

-

-

-

$437,660

$64,551
$247,255

$239,436

$4,488,138
$282,976

$865,846
$1,345,080
$256,625

$562,618
$137,717
$248,295

Source Dignity Health

57



Catholic School Health Nurse: The hospital sponsors a nurse to provide health care and
screenings to low income children at five Catholic schools;



Chronic Disease Self-Management Program: The program offers weekly workshops for
six weeks on diabetes in clinical and community settings as well as on other chronic
health problems;



El Hogar Refer Net: In collaboration with the community based nonprofit mental health
provider, El Hogar, this program provides a process for patients admitted to the
emergency department with mental illness to receive immediate and ongoing treatment
and other social services they need after leaving the hospital;



Lutheran Social Services Homeless Housing: This program partners hospital care
coordinators with Lutheran Social Services staff to identify and evaluate chronically
homeless, high end hospital users and place them in transitional housing units;

 58



Patient Navigation Program: In partnership with Sacramento Covered and Health Net,
this program assists underserved patients who are admitted to the emergency
department for non-urgent care by connecting with a primary care provider, community
clinics, and other social support services;



Sacramento Community Partnerships: A collaboration with other regional health
providers and community based nonprofit organizations to address specific priorities
identified in the Community Needs Assessment and unmet healthcare needs;



Safe Kids Car Seat Classes and Health/Safety Education: Provides education for children
and families on child passenger safety, bicycle safety, pedestrian safety, home safety,
safe sleep, fire/burn prevention, drowning prevention, and poison prevention, and
distributes lifesaving devices to families in need;



Wellspace Interim Care Program: A collaboration between other Dignity Health hospitals
and health systems in the region, Sacramento County and Federally Qualified Health
Center, WellSpace Health, to provide shelter and treatment for homeless patients with
physical or mental health disorders. The program also provides case management
services to connect participants with outpatient services and community resources;



Counseling Service – Poor: Psychiatric consults for patients who are uninsured and
require psychiatric medical evaluations while hospitalized and conservatorship services
to low-income patients who may lack capacity or family to help make decisions;



Emergency and Trauma Services (Ambulance Services): Subsidized services for
emergency and trauma patients, including ambulance and air ambulance transport;



Mercy Family Health Center (Family Practice Residency): Resident physicians are
sponsored by the hospital to provide primary health care services to the poor and
underinsured at the Mercy Family Health Center located on the campus of Methodist
Hospital;



Renal Dialysis Services: The Care Coordination Department pays for dialysis services for
the underserved;



Cash – In Kind Donations – Poor: Cash and in-kind donations by the hospital to nonprofit
community-based organizations that provide health related services for the
underinsured, uninsured, and vulnerable populations in the community;

 59



Dignity Health Community Grants: Funding from the hospital awarded to nonprofit
organizations working to improve the health and well-being of vulnerable and
underserved populations and reduce disparities in the community;



Sacramento Service Area Partnerships/Donations – Poor: A collaboration with other
regional health providers and community based nonprofit organizations to address
specific priorities identified in the Community Needs Assessment and unmet healthcare
needs;



Transitional Housing and Lodging – Poor: Provides payment for short-term room and
board in the community for patients unable to pay this expense after they are
discharged from the hospital;



Community Benefit Assigned Staff: A dedicated Community Health and Outreach team
that oversees community health and outreach activities and reporting for all
Sacramento region hospitals, develops the Sacramento Service Area Community Needs
Assessment, and develops strategic partnerships working collaboratively with other
health providers and community based organizations to focus on disproportionate
unmet needs.



Mercy Faith & Health Partnership: A community outreach program that encourages,
supports and nurtures local faith communities to develop and sustain health ministry
programs that advocate health promotion and disease prevention in their communities;



Mercy Heart & Vascular Institute – Cardiovascular Disease Management: This program
runs CHAMP (Congestive Heart Active Management Program) that provides patients
with phone interventions, educational classes, and disease management skills after they
are discharged from the Hospital;



Professional & Medical Education – Nursing: Seminars and training for nurses focused
on the health of the broader community. This includes Hospital staff serving as
preceptors to students;



Professional & Medical Education – Other: Education for medical students, physicians,
nurses, and other healthcare professionals. This includes Hospital staff serving as
preceptors to students; and

 

Mercy Foundation – A nonprofit organization raising philanthropic support and
community awareness for the works of the Sisters of Mercy in healthcare, education,
housing for the homeless, and care for the poor and elderly.

Reproductive Health
Mercy San Juan Medical Center reported 64 inpatient discharges related to reproductive health
services for CY 2016.27 The table below lists inpatient reproductive services by diagnostic
related group (DRG) discharges for CY 2016.
MERCY SAN JUAN MEDICAL CENTER
CY 2016 REPRODUCTIVE SERVICE BY DIAGNOSTIC RELATED GROUP
Discharges
778-Threatened Abortion
31
767-Vaginal Delivery W Sterilization &/Or D&C1
23
777-Ectopic Pregnancy
5
1
770-Abortion W D&C , Aspiration Curettage Or Hysteroctomy
4
779-Abortion W/O D&C1
1
Total Discharges:
64
Source: CY 2016 OSHPD Patient Discharge Database
1D&C is an abbreviation for Dilation and Curettage

● Out of the five diagnostic related groups, DRG 778-threatened abortions has the highest
number of reproductive service inpatient discharges.

27

Mercy San Juan Medical Center is a Catholic hospital and is subject to the Catholic ERDs

60

 The following table indicates whether the Hospital performs the following women’s health
reproductive services.
MERCY SAN JUAN MEDICAL CENTER
REPRODUCTIVE SERVICES
Currently Performed?
Procedure
(Y/N)
Caesarean delivery with sterilization
Yes, In specific situations following approval
Terminate pregnancy when:
A. Placenta previa
No
B. Premature rupture of membranes
No
C. Second trimester bleeding with previable fetus
No
Placement of an IUD at time of other gynecological
surgery
No
Postpartum placement of IUD
No
Gender affirming surgery
No
Emergency contraception as emergency room or
inpatient service
No
Ectopic pregnancy treatment with methotrexate
(medication in lieu of surgery)
No
Source: Dignity Health

61

 Analysis of Mercy San Juan Medical Center
Service Area Definition
Mercy San Juan Medical Center’s service area is comprised of 31 ZIP Codes from which 75.9% of
its discharges originated in CY 2016. Approximately 50% of Mercy San Juan Medical Center’s
discharges originated from the top eight ZIP Codes. In CY 2016, Mercy San Juan Medical
Center’s s market share in the service area was 18.0%.

ZIP Codes
Community
95608
Carmichael
95660
North Highlands
95621
Citrus Heights
95610
Citrus Heights
95628
Fair Oaks
95842
Sacramento
95841
Sacramento
95843
Antelope
95670
Rancho Cordova
95821
Sacramento
95662
Orangevale
95838
Sacramento
95673
Rio Linda
95630
Folsom
95747
Roseville
95815
Sacramento
95678
Roseville
95825
Sacramento
95864
Sacramento
95626
Elverta
95827
Sacramento
95661
Roseville
95826
Sacramento
95746
Granite Bay
95742
Rancho Cordova
95609
Carmichael
95611
Citrus Heights
95655
Mather
95652
Mcclellan
95741
Rancho Cordova
95860
Sacramento
Subtotal
Other ZIPs
Total Discharges

MERCY SAN JUAN MEDICAL CENTER
PATIENT ORIGIN CY 2016
Total
% of
Cumulative %
Discharges
Discharges
of Discharges
2,260
11.5%
11.5%
1,490
7.6%
19.0%
1,297
6.6%
25.6%
1,156
5.9%
31.5%
1,069
5.4%
36.9%
1,054
5.3%
42.3%
893
4.5%
46.8%
797
4.0%
50.8%
717
3.6%
54.5%
670
3.4%
57.9%
495
2.5%
60.4%
475
2.4%
62.8%
457
2.3%
65.1%
310
1.6%
66.7%
266
1.3%
68.0%
232
1.2%
69.2%
230
1.2%
70.4%
200
1.0%
71.4%
151
0.8%
72.2%
138
0.7%
72.9%
133
0.7%
73.5%
132
0.7%
74.2%
132
0.7%
74.9%
53
0.3%
75.1%
42
0.2%
75.4%
40
0.2%
75.6%
29
0.1%
75.7%
19
0.1%
75.8%
12
0.1%
75.9%
11
0.1%
75.9%
6
0.0%
75.9%
14,966
75.9%
75.9%
4,740
24.1%
100%
19,706
100%

Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

62

Total Area
Discharges
6,429
4,169
4,455
4,273
3,751
3,286
2,381
3,520
5,180
3,881
2,951
4,120
1,819
4,558
4,792
3,433
3,412
3,519
1,821
571
2,093
2,583
3,195
1,406
825
128
110
280
69
108
68
83,186

Market
Share
35.2%
35.7%
29.1%
27.1%
28.5%
32.1%
37.5%
22.6%
13.8%
17.3%
16.8%
11.5%
25.1%
6.8%
5.6%
6.8%
6.7%
5.7%
8.3%
24.2%
6.4%
5.1%
4.1%
3.8%
5.1%
31.3%
26.4%
6.8%
17.4%
10.2%
8.8%
18.0%

 Service Area Map
Mercy San Juan Medical Center’s service area has approximately 920,000 residents. There are
five other hospitals located within Mercy San Juan Medical Center’s service area. There are
eight other hospitals approximately 15 miles from the Hospital’s service area. Mercy San Juan
Medical Center is the inpatient market share leader in the service area.

63

 Hospital Market Share
The table below provides the market share of inpatient discharges by individual hospital within
Mercy San Juan Medical Center’s service area from CY 2013 to CY 2016.
MERCY SAN JUAN MEDICAL CENTER
MARKET SHARE BY HOSPITAL CY 2013 - CY 2016
Hospital
CY 2013 CY 2014
Mercy San Juan Medical Center
21.4%
22.3%
Kaiser Foundation Hospital - Roseville
12.9%
13.3%
Sutter Roseville Medical Center
13.1%
12.7%
Sutter Medical Center, Sacramento
7.3%
6.9%
University of California Davis Medical Center
9.7%
9.4%
Kaiser Foundation Hospital - Sacramento
6.6%
6.3%
Mercy General Hospital
7.4%
7.4%
Mercy Hospital Of Folsom
4.4%
4.8%
Sierra Vista Hospital
2.0%
1.7%
Heritage Oaks Hospital
1.8%
1.8%
Methodist Hospital of Sacramento
1.3%
1.4%
Kaiser Foundation Hospital - South Sacramento
1.0%
1.2%
Sutter Center For Psychiatry
1.1%
1.1%
UCSF Medical Center
0.4%
0.4%
Woodland Memorial Hospital
0.2%
0.3%
St. Joseph's Behavioral Health Center
0.5%
0.6%
Adventist Health Vallejo
0.0%
0.2%
Fremont Hospital
0.0%
0.0%
Sutter Davis Hospital
0.2%
0.2%
Crestwood Psychiatric Health Facility-Carmichael
0.4%
0.4%
Shriners Hospitals for Children Northern Calif.
0.1%
0.2%
Stanford Health Care
0.2%
0.2%
All Other
8.0%
7.1%
Total Percentage
100%
100%
Total Discharges
82,643
83,289

CY 2015
21.0%
14.3%
11.8%
6.9%
8.9%
6.8%
6.9%
5.1%
1.8%
2.0%
1.5%
1.5%
1.1%
0.4%
0.4%
0.6%
0.3%
0.2%
0.3%
0.2%
0.2%
0.2%
7.8%
100%
83,303

CY 2016
18.0%
15.0%
13.4%
11.5%
9.0%
7.5%
6.1%
5.1%
1.8%
1.8%
1.6%
1.6%
1.0%
0.5%
0.5%
0.4%
0.3%
0.3%
0.2%
0.2%
0.2%
0.2%
3.7%
100%
83,186

Source: OSHPD Discharge Database, CY 2013 - CY 2016
Note: Excludes normal newborns

64



The number of discharges in Mercy San Juan Medical Center’s service area remained
relatively stable;



Since CY 2013 to CY 2016, Mercy San Juan Medical Center consistently ranked first in
terms of overall market share for its service area (18.0% of inpatient discharges in CY
2016); and



In CY 2016, Kaiser Foundation Hospital- Roseville ranked second in market share (15%),
followed by Sutter Roseville Medical Center (13%).

Trend
↘
↗
→
↗
↘
↗
↘
↗
→
→
↗
↗
→
→
↗
→
→
↗
→
↘
→
→
↘
→

 Market Share by Payer Types
The following table provides the service area’s hospital inpatient market share by payer type as
reported by OSHPD for CY 2016.

Sutter Medical Center, Sacramento

University Of California Davis Medical
Center

Kaiser Foundation Hospital Sacramento

Mercy General Hospital

Mercy Hospital Of Folsom

83,186

Sutter Roseville Medical Center

Total
Discharges
31,841
24,643
23,483
2,296
923

Kaiser Foundation Hospital - Roseville

Payer Type
Medicare
Private Coverage
Medi-Cal
All Other
Self-Pay
Total Percentage
Total Discharges

Mercy San Juan Medical Center

MERCY SAN JUAN MEDICAL CENTER
HOSPITAL MARKET SHARE BY PAYER CY 2016

21.5%
8.8%
23.8%
11.8%
10.6%
18.0%
14,966

13.3%
26.0%
7.2%
1.0%
13.3%
15.0%
12,494

16.8%
13.1%
8.7%
12.4%
24.1%
13.4%
11,120

7.8%
9.0%
17.8%
22.9%
15.2%
11.5%
9,555

7.6%
9.3%
11.1%
8.5%
1.4%
9.0%
7,503

11.2%
6.3%
4.1%
1.1%
11.5%
7.5%
6,207

7.7%
4.1%
6.4%
3.0%
2.5%
6.1%
5,071

6.0%
5.8%
3.3%
4.1%
4.8%
5.1%
4,260

All
Others
8.1%
17.7%
17.5%
35.2%
16.7%
14.4%
12,010

Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%

Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

65



The largest payer type for inpatient discharges is Medicare with 31,841 discharges
(38%), Private Coverage with over 24,600 discharges (30%), and Medi-Cal with
approximately 23,400 discharges (28%);



Mercy San Juan Medical Center is the market share leader for Medicare (22%) and
Medi-Cal (24%); and



Kaiser Foundation Hospital - Roseville is the market share leader for Private Coverage
(26%).

 Market Share by Service Line
The following table shows the service area’s inpatient market share by service line for CY 2016.

66

Kaiser Foundation
Hospital - Roseville

Sutter Roseville Medical
Center

Sutter Medical Center,
Sacramento

University Of California
Davis Medical Center

Kaiser Foundation
Hospital - Sacramento

Mercy General Hospital

Mercy Hospital Of Folsom

Total
Service Line
Discharges
General Medicine
24,789
Obstetrics
12,021
Cardiac Services
8,177
General Surgery
7,430
Behavioral Health
6,746
Orthopedics
6,480
Neonatology
4,189
Neurology
3,476
Oncology/Hematology (Medical)
2,173
Spine
1,602
Other
1,419
Urology
952
Vascular Services
950
Gynecology
838
ENT
801
Neurosurgery
653
Rehabilitation
228
No-match-found
176
Total Percentage
Total Discharges
83,186
Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

Mercy San Juan Medical
Center

MERCY SAN JUAN MEDICAL CENTER
HOSPITAL MARKET SHARE BY SERVICE LINE CY 2016

22.8%
13.4%
23.2%
18.3%
3.5%
15.4%
12.5%
23.8%
19.0%
7.9%
26.5%
20.8%
25.3%
23.7%
17.0%
17.3%
0.0%
17.0%
18.0%
14,966

13.1%
28.7%
13.0%
11.9%
0.6%
16.3%
38.7%
10.4%
13.2%
2.1%
4.8%
9.9%
14.1%
4.9%
9.7%
2.5%
0.0%
4.0%
15.0%
12,494

15.9%
11.9%
14.4%
14.5%
1.2%
16.2%
10.1%
15.7%
11.8%
16.3%
18.1%
19.9%
12.2%
17.1%
11.9%
7.5%
0.0%
8.5%
13.4%
11,120

9.6%
25.2%
9.6%
8.0%
0.9%
8.2%
17.5%
10.0%
13.7%
12.5%
3.9%
8.7%
15.2%
12.3%
10.0%
13.3%
0.0%
15.9%
11.5%
9,555

10.3%
4.7%
8.1%
12.0%
1.0%
9.3%
6.9%
9.0%
18.5%
12.3%
22.8%
12.1%
10.4%
6.8%
24.5%
15.9%
6.6%
17.0%
9.0%
7,503

10.5%
0.1%
7.5%
10.5%
0.9%
10.9%
0.0%
11.7%
7.0%
24.8%
5.5%
4.8%
7.1%
9.7%
5.0%
24.8%
0.0%
7.4%
7.5%
6,207

6.0%
3.4%
14.6%
6.1%
0.7%
6.5%
1.9%
5.9%
5.4%
10.7%
2.3%
2.9%
9.9%
10.0%
5.4%
4.6%
75.9%
2.3%
6.1%
5,071

6.7%
4.6%
5.0%
7.4%
0.8%
5.5%
2.9%
5.7%
4.4%
5.9%
1.8%
6.5%
1.5%
4.4%
3.1%
0.0%
0.0%
2.3%
5.1%
4,260

All
Others
5.2%
8.0%
4.5%
11.5%
90.3%
11.6%
9.5%
7.8%
7.0%
7.6%
14.2%
14.4%
4.4%
11.1%
13.5%
14.1%
17.5%
25.6%
14.4%
12,010



Mercy San Juan Medical Center is the service line leader in eleven of 18 service lines
including: general medicine (23%), cardiac services (23%), general surgery (18%), and
neurology (24%);



Kaiser Foundation Hospital - Roseville is the service area inpatient service line leader in
three of 18 service lines: obstetrics (29%), orthopedics (16%), and neonatology (39%);
and



Kaiser Foundation Hospital - Sacramento is the service area inpatient service line leader
in spine (25%) and neurosurgery (25%).

Total
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%

 Market Share by ZIP Code
The following table illustrates the service area’s hospital market share by ZIP Code for CY 2016.

67

Kaiser Foundation Hospital –
Roseville

Sutter Roseville Medical Center

Sutter Medical Center,
Sacramento

University Of California Davis
Medical Center

Kaiser Foundation Hospital –
Sacramento

Mercy General Hospital

Mercy Hospital Of Folsom

Total
ZIP Code
Community
Discharges
95608
Carmichael
6,429
95670
Rancho Cordova
5,180
95747
Roseville
4,792
95630
Folsom
4,558
95621
Citrus Heights
4,455
95610
Citrus Heights
4,273
95660
North Highlands
4,169
95838
Sacramento
4,120
95821
Sacramento
3,881
95628
Fair Oaks
3,751
95843
Antelope
3,520
95825
Sacramento
3,519
95815
Sacramento
3,433
95678
Roseville
3,412
95842
Sacramento
3,286
95826
Sacramento
3,195
95662
Orangevale
2,951
95661
Roseville
2,583
95841
Sacramento
2,381
95827
Sacramento
2,093
95864
Sacramento
1,821
95673
Rio Linda
1,819
95746
Granite Bay
1,406
95742
Rancho Cordova
825
95626
Elverta
571
95655
Mather
280
95609
Carmichael
128
95611
Citrus Heights
110
95741
Rancho Cordova
108
95652
Mcclellan
69
95860
Sacramento
68
Total Percentage
Total Discharges
83,186
Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

Mercy San Juan Medical Center

MERCY SAN JUAN MEDICAL CENTER
HOSPITAL MARKET SHARE BY ZIP CODE CY 2016

35.2%
13.8%
5.6%
6.8%
29.1%
27.1%
35.7%
11.5%
17.3%
28.5%
22.6%
5.7%
6.8%
6.7%
32.1%
4.1%
16.8%
5.1%
37.5%
6.4%
8.3%
25.1%
3.8%
5.1%
24.2%
6.8%
31.3%
26.4%
10.2%
17.4%
8.8%
18.0%
14,966

9.7%
10.4%
26.9%
19.4%
22.0%
20.4%
10.8%
8.2%
7.3%
18.6%
22.0%
5.2%
5.0%
22.7%
16.3%
8.3%
23.9%
24.9%
10.9%
7.9%
6.9%
13.7%
21.8%
20.2%
19.1%
19.6%
3.9%
17.3%
8.3%
4.3%
8.8%
15.0%
12,494

4.9%
3.8%
44.1%
6.4%
19.1%
18.9%
9.6%
1.9%
2.8%
10.5%
20.4%
1.1%
1.4%
44.2%
11.7%
1.4%
16.7%
45.1%
7.4%
1.5%
2.2%
8.6%
42.2%
4.1%
12.8%
3.2%
10.2%
19.1%
2.8%
14.5%
1.5%
13.4%
11,120

11.0%
12.6%
4.3%
4.3%
5.5%
5.9%
10.0%
23.4%
18.9%
5.9%
8.9%
25.7%
27.0%
5.2%
9.7%
18.9%
4.4%
3.6%
8.5%
16.0%
23.0%
12.6%
5.5%
10.2%
11.2%
12.1%
7.8%
7.3%
3.7%
15.9%
16.2%
11.5%
9,555

8.0%
16.4%
4.7%
7.6%
4.9%
6.1%
8.1%
13.0%
10.5%
7.5%
6.6%
10.7%
12.3%
4.6%
7.2%
17.2%
5.7%
4.6%
7.3%
18.8%
11.0%
8.3%
5.2%
16.5%
8.8%
13.6%
3.1%
7.3%
18.5%
7.2%
16.2%
9.0%
7,503

11.8%
9.2%
2.4%
2.3%
2.6%
2.3%
7.3%
10.3%
16.3%
4.2%
2.6%
18.0%
11.6%
1.5%
4.2%
14.8%
2.6%
2.2%
5.5%
12.0%
16.5%
11.3%
2.6%
6.4%
6.0%
11.1%
21.1%
1.8%
12.0%
11.6%
17.6%
7.5%
6,207

4.4%
5.9%
1.4%
4.5%
2.9%
2.9%
4.2%
14.1%
9.3%
3.5%
3.0%
15.2%
14.7%
1.5%
3.3%
13.2%
3.3%
1.7%
2.3%
12.2%
15.6%
7.1%
1.6%
4.6%
4.9%
5.0%
7.0%
1.8%
1.9%
7.2%
2.9%
6.1%
5,071

2.1%
13.4%
0.8%
35.1%
1.9%
3.9%
0.8%
0.5%
0.7%
9.4%
1.1%
0.5%
0.3%
1.1%
0.9%
1.4%
16.2%
1.4%
1.2%
6.7%
1.2%
0.6%
3.3%
14.2%
0.7%
6.4%
3.1%
3.6%
16.7%
0.0%
4.4%
5.1%
4,260

All
Others
13.1%
14.5%
9.9%
13.6%
11.9%
12.6%
13.5%
16.9%
16.9%
11.9%
12.9%
17.8%
20.9%
12.4%
14.6%
20.6%
10.4%
11.3%
19.4%
18.7%
15.3%
12.6%
13.9%
18.7%
12.4%
22.1%
12.5%
15.5%
25.9%
21.7%
23.5%
14.4%
12,010

Total
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%



Mercy San Juan Medical Center is the inpatient market share leader in 13 of the 31 ZIP
Codes within the Cities of Carmichael, Citrus Heights, North Highlands, Fair Oaks,
Antelope, Sacramento, Rio Linda, Elverta, and Mcclellan; and



Sutter Medical Center, Sacramento is the inpatient market share leader in six of the
service area ZIP Codes within the Cities of Roseville and Granite Bay.

 Profile of Mercy Hospital of Folsom
Overview
Mercy Hospital of Folsom is a general acute care hospital located on 1650 Creekside Drive in
Folsom, California. The Hospital was established in 1980 after the Sisters of Mercy purchased
Twin Lakes Community Hospital and renamed it Mercy Hospital of Folsom.
Today, Mercy Hospital of Folsom offers a range of services including: obstetrics, critical care
medicine, cardiovascular care. The hospital has four surgical operating rooms and basic
emergency department with 25 emergency treatment stations. According to Mercy Hospital of
Folsom’s current hospital license, the Hospital is licensed for 106 beds as shown below.
MERCY HOSPITAL OF FOLSOM
LICENSED BED DISTRIBUTION 2018
Licensed Bed Type
Number of Beds1
General Acute Care Beds
Perinatal
8
Intensive Care
8
Unspecified General Acute Care
90
Total General Acute Care Beds
106
Total Licensed Beds
106
1

68

2018 Hospital License

 Key Statistics
For FY 2017, Mercy Hospital of Folsom reported 6,880 inpatient discharges, 23,633 patient
days, and an average daily census of 65 patients (approximately 61% occupancy).

Inpatient Discharges
Licensed Beds
Patient Days
Average Daily Census
Occupancy
Average Length of Stay
Emergency Service Visits
Total Live Births

MERCY HOSPITAL OF FOLSOM
KEY STATISTICS FY 2015 - FY 20171
FY 2015
7,191
106
22,779
62
58.9%
3.2
43,147
927

FY 2016
6,843
106
24,271
66
62.7%
3.5
45,555
833

FY 2017
6,880
106
23,633
65
61.1%
3.4
48,421
880

Sources: OSHPD Disclosure Reports, FY 2015 - FY 2017
1 FY 2015 and FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 data is from unaudited.

69



Since FY 2015, inpatient discharges have decreased by 5%;



In FY 2017, 48,421 emergency service visits were reported, a 12% increase from FY
2015;



Between FY 2013 and FY 2017, total live births have remained relatively constant, with
an average of 880 live births annually.

 Patient Utilization Trends
The following table shows FY 2013 – FY 2017 volume trends at Mercy Hospital of Folsom.
MERCY HOSPITAL OF FOLSOM
SERVICE VOLUMES FY 2013 - FY 20171
PATIENT DAYS
FY 2013 FY 2014 FY 2015 FY 2016
Medical/Surgical2
14,139
15,825
18,197
19,991
Intensive Care
2,120
1,980
2,212
2,229
Obstetrics
1,975
1,983
2,022
1,799
Total
18,234
19,788
22,431
24,019
DISCHARGES
Medical/Surgical2
4,626
4,800
5,140
4,891
Intensive Care
252
237
213
203
Obstetrics
924
939
942
827
Total
5,802
5,976
6,295
5,921
AVERAGE LENGTH OF STAY
Medical/Surgical2
3.1
3.3
3.5
4.1
Intensive Care
8.4
8.4
10.4
11.0
Obstetrics
2.1
2.1
2.1
2.2
Total
3.1
3.3
3.6
4.1
AVERAGE DAILY CENSUS
Medical/Surgical2
38.7
43.4
49.9
54.8
Intensive Care
5.8
5.4
6.1
6.1
Obstetrics
5.4
5.4
5.5
4.9
Total
50
54
61
66
OTHER SERVICES
Inpatient Surgeries
1,450
1,544
1,668
1,911
Outpatient Surgeries
1,496
1,613
1,735
1,830
Emergency Service Visits
34,945
37,177
43,147
45,555
Total Live Births
914
929
927
833
Sources: OSHPD Disclosure Reports, FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.
2 Includes Definitive Observation Beds

FY 2017
19,464
2,011
1,831
23,306
5,765
211
867
6,843
3.4
9.5
2.1
3.4
53.3
5.5
5.0
64
1,917
1,815
48,421
880

A review of Mercy Hospital of Folsom’s historical utilization trends between FY 2013 and FY
2017 supports the following conclusions:

70



Total patient days have increased by 28%;



Inpatient discharges have increased by 18%;



The average daily census has increased by 7% from 61 patients in FY 2015 to 66 patients
in FY 2016, followed by a 3% decrease in FY 2017; and



Emergency service visits have increased significantly by 39%.

 Financial Profile
Over the last five fiscal years, Mercy Hospital of Folsom has had a positive net income ranging
from $30.5 million in FY 2013 to $70.9 million FY 2017. Between FY 2013 and FY 2017, net
patient revenue and total operating revenue increased by nearly 47% and 44% respectively.
Over the same period, the Hospital’s operating expenses increased by 36% from $145.1 million
in FY 2013 to $197.9 million in FY 2017. Other operating revenue decreased significantly over
the five-year period by 75% from $4.6 million to $1.1 million.
The Hospital’s current ratio has increased over the last five years from 5.77 in FY 2013 to 14.72
in FY 2017. The California average in FY 2016 was 1.56. The Hospital’s percentage of bad debt is
1.3% and greater than the statewide average of 0.8%.

Patient Days
Discharges
ALOS
Net Patient Revenue
Other Operating Revenue
Total Operating Revenue
Operating Expenses
Net from Operations
Net Non-Operating Revenues and Expenses
Net Income

MERCY HOSPITAL OF FOLSOM
FINANCIAL AND RATIO ANALYSIS FY 2013 - FY 20171
FY 2013
FY 2014
FY 2015
18,680
20,191
22,779
4,981
6,863
7,191
3.8
2.9
3.2
$164,456,622
$4,604,314
$169,060,936
$145,077,110
$23,983,826
$6,497,806
$30,481,632

$178,792,156
$4,777,944
$183,570,100
$145,776,596
$37,793,504
$9,728,496
$47,522,000

$211,238,058
$3,703,470
$214,941,528
$169,205,049
$45,736,479
$4,215,496
$49,951,975

FY 2016
24,271
6,843
3.5

FY 2017
23,633
6,880
3.4

-

$230,516,401
$1,309,062
$231,825,463
$184,731,173
$47,094,290
$883,967
$47,978,257

$242,235,320
$1,144,469
$243,379,789
$197,943,827
$45,435,962
$25,437,898
$70,873,860

2016
California
Average2

Current Ratio
5.77
8.83
10.28
9.96
Days in A/R
44.2
50.0
47.7
46.5
Bad Debt Rate
3.5%
3.4%
1.9%
1.6%
Operating Margin
14.19%
20.59%
21.28%
20.31%
Source: OSHPD Disclosure Reports, FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.
2 FY 2017 California data was not available when the data was collected to prepare this report.

71

14.72
44.0
1.3%
18.67%

1.56
57.1
0.8%
2.74%

 Cost of Hospital Services
Mercy Hospital of Folsom’s operating cost of services includes both inpatient and outpatient
care. In FY 2017, approximately 41% of total costs were associated with Medicare, followed by
34% with Third-Party, and 22% with Medi-Cal.

Operating Expenses

MERCY HOSPITAL OF FOLSOM
OPERATING EXPENSES BY PAYER CATEGORY FY 2013 - FY 20171
FY 2013
FY 2014
FY 2015
$145,077,110
$145,776,596
$169,205,049

Cost of Services By Payer:
Medicare
$50,988,590
$57,239,976
$68,814,026
Medi-Cal
$18,745,367
$21,643,757
$34,118,902
County Indigent
$3,857,795
$2,677,625
$61,045
Third-Party
$64,110,607
$57,857,599
$62,819,607
Other Indigent
$1,246,207
$449,911
$626,665
All Other Payers
$6,128,544
$5,907,728
$2,764,804
Source: OSHPD Disclosure Reports, FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.

FY 2016
$184,731,173

FY 2017
$197,943,827

$74,844,325
$39,890,177
$16,132
$67,017,225
$454,070
$2,509,243

$81,891,187
$43,813,683
$68,164,577
$902,180
$3,172,199

Charity Care
The following table shows a comparison of charity care and bad debt for Mercy Hospital of
Folsom and all general acute care hospitals in the State of California. The five-year (FY 2013 – FY
2017) average of charity care and bad debt, as a percentage of gross patient revenue, was 3%
and higher than the four-year statewide average of 2.5%. According to OSHPD, “…the
determination of what is classified as charity care can be made by establishing whether or not
the patient has the ability to pay. The patient’s accounts receivable must be written off as bad
debt if the patient has the ability but is unwilling to pay off the account.”
MERCY HOSPITAL OF FOLSOM
CHARITY CARE COMPARISON FY 2013 - FY 20171 (In Thousands)
FY 2013
Hospital
$607,752
$6,206
$21,563
$27,769
1.0%
3.5%
4.6%

CA
$320,382,471
$6,563,487
$5,891,632
$12,455,119
2.0%
1.8%
3.9%

FY 2014
Hospital
$651,787
$3,536
$21,876
$25,413
0.5%
3.4%
3.9%

CA
$338,322,364
$5,113,965
$4,365,936
$9,479,902
1.5%
1.3%
2.8%

Gross Patient Revenue
Charity
Bad Debt
Total Charity & Bad Debt
Charity Care as a % of Gross Patient Revenue
Bad Debt as a % of Gross Patient Revenue
Total as a % of Gross Patient Revenue
Uncompensated Care
Cost to Charge Ratio
23.1%
24.5%
21.6%
23.6%
Charity
$1,434
$1,608,711
$765
$1,207,919
Bad Debt
$4,984
$1,444,039
$4,732
$1,031,234
Total
$6,418
$3,052,750
$5,497
$2,239,153
Source: OSHPD Disclosure Reports FY 2013 - FY 2017
1
FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.
2
FY 2017 California data was not available when the data was collected to prepare this report .

72

FY 2015

FY 2016

Hospital
$772,215
$4,595
$14,425
$19,020
0.6%
1.9%
2.5%

CA
$365,501,463
$3,441,227
$3,262,642
$6,703,869
0.9%
0.9%
1.8%

Hospital
$890,343
$3,442
$14,384
$17,826
0.4%
1.6%
2.0%

CA
$396,427,743
$3,457,868
$3,108,971
$6,566,839
0.9%
0.8%
1.7%

21.4%
$985
$3,092
$4,076

24.1%
$828,647
$785,644
$1,614,292

20.6%
$709
$2,963
$3,672

23.8%
$822,627
$739,624
$1,562,251

FY 2017
Hospital
CA 2
$962,726
$5,459
$12,513
$17,972
0.6%
1.3%
1.9%
20.4%
$1,116
$2,558
$3,674

-

 The following table shows the Hospital’s historical costs for charity care as reported to OSHPD.
Charity care costs have decreased from approximately $1.4 million in FY 2013 to $1.1 million in
FY 2017. The average cost of charity care for the last five-year period was approximately $1.0
million, while the three-year average cost of charity care was $936,615.
MERCY HOSPITAL OF FOLSOM
COST OF CHARITY CARE FY 2013 - FY 20171

Year
FY 2017
FY 2016
FY 2015
FY 2014
FY 2013
FY 2015 - FY 2017 Average
FY 2013 - FY 2017 Average

Charity Care
Charges
$5,459,285
$3,442,117
$4,594,725
$3,536,447
$6,205,515

Cost to
Charge Ratio
20.4%
20.6%
21.4%
21.6%
23.1%

Cost of Charity
Care to the
Hospital
$1,115,981
$709,120
$984,744
$765,027
$1,434,313
$936,615
$1,001,837

Source: OSHPD Disclosure Reports FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.

In the application to the California Attorney General, Dignity Health reported the following
combined distribution of charity care costs by inpatient, outpatient, and emergency room costs.
MERCY HOSPITAL OF FOLSOM
COST OF CHARITY CARE BY SERVICE FY 2013 - FY 2017
Inpatient Outpatient Emergency Room Total Costs
FY 2017:
Cost of Charity
Visits/Discharges
FY 2016:
Cost of Charity
Visits/Discharges
FY 2015:
Cost of Charity
Visits/Discharges
FY 2014:
Cost of Charity
Visits/Discharges
FY 2013:
Cost of Charity
Visits/Discharges

$314,663
19

$344,919
124

$349,883
368

$1,009,465

$191,100
12

$205,838
82

$213,904
245

$610,842

$578,639
39

$317,311
115

$305,210
371

$1,201,160

$275,315
19

$221,345
84

$197,757
228

$694,417

$630,662
47

$299,854
145

$356,262
385

$1,286,778

Source: Dignity Health

Note that these totals are different than what Dignity Health reported to OSHPD. However,
after discussion with JD Healthcare Inc. and Vizient Inc., Dignity Health has acknowledged that
an error was made in its calculation of charity care costs. Dignity Health has stated that they
will comply with the charity care cost amounts determined in the manner described above.

73

 Community Benefit Services
In the last five years, Mercy Hospital of Folsom has spent a significant amount on community
benefit services. As shown in the table below, the average annual cost of community benefit
services over the last three years has been $1.3 million. The average annual cost of community
benefit services over the last five years has been $1.7 million.
MERCY HOSPITAL OF FOLSOM
COMMUNITY BENEFIT SERVICES FY 2013 - FY 2017
Community Benefit Programs
Benefits for Living in Poverty
Benefits for Broader Community
Totals
Medi-Cal Provider Fee CHFT Grant Expense
Adjusted Totals
Source: Dignity Health

FY 2013
$3,072,892
$156,478
$3,229,370
$3,229,370

FY 2014
$1,242,350
$121,491
$1,363,841
$1,363,841

FY 2015
$1,256,332
$247,159
$1,503,491
($42,284)
$1,461,207

FY 2016
$802,459
$697,843
$1,500,302
($27,156)
$1,473,146

FY 2017
$679,260
$354,102
$1,033,362
($11,376)
$1,021,986

FY 2015 – FY 2017
Average
$912,684
$433,035
$1,345,718
$1,318,780

FY 2013 – FY 2017
Average
$1,410,659
$315,415
$1,726,073
$1,709,910

● The Hospital’s five-year average cost of community benefit services for persons living in
poverty is $1.4 million per year;
● The Hospital’s five-year average cost of community benefit services for the broader
community is $315,000 per year; and
● Over the five-year period, the Hospital’s adjusted total cost of community benefit
services decreased from $3.2 million in FY 2013 to $1.0 million in FY 2017.

74

 The Hospital’s community benefit services over the past five fiscal years include the following
programs over $10,000:
MERCY HOSPITAL FOLSOM
COST OF COMMUNITY BENEFIT SERVICES FY 2013 - FY 2017
Services over $10,000 in cost in FY 2017:
FY 2013
FY 2014
FY 2015
Charity Prescriptions
$5,315
$203
$9,403
Chronic Disease Self-Management Program
$15,487
$14,301
$18,864
El Hogar Refer Net
Lutheran Social Services Homeless Housing
Patient Navigator Program
$60,046
$26,503
Sacramento Community Partnerships
$44,308
Counseling Service-Poor
$168,188 $240,698 $228,024
Cash-In Kind Donations-Poor
$19,994
$21,949 $144,093
Dignity Health Community Grants
$70,841
$78,432
$72,718
CHFT Hospital Grant Program
$42,284
Transitional Housing and Lodging -Poor
$46
$298
$7,100
Community Benefit Assigned Staff
$55,663 $117,596 $126,441
Mercy Faith & Health Partnership
$7,525
$10,315
$9,249
Mercy Heart & Vascular Institute - Cardiovascular Disease
Management (Congestive Heart Active Management
Program)
Professional & Medical Education - Nursing
- $121,261
Professional & Medical Education - Other
Mercy Foundation Support
$52,801
$70,328
$77,894

FY 2016
$13,075
$14,256
$13,078
$38,250
$181,410
$42,446
$73,045
$27,156
$232
$124,647
$9,632

FY 2017
$16,278
$20,354
$11,527
$15,000
$18,130
$13,800
$209,081
$55,224
$84,833
$11,376
$67,350
$122,184
$10,317

$200,568
$359,615
$69,084

$109,415
$115,546
$45,347
$65,339

Source: Dignity Health

75



Charity Prescriptions: Donation of prescription medications to uninsured and
underserved patients;



Chronic Disease Self-Management Program: The program offers weekly workshops for
six weeks on diabetes in clinical and community settings as well as on other chronic
health problems;



El Hogar Refer Net: In collaboration with the community based nonprofit mental health
provider, El Hogar, this program provides a process for patients admitted to the
emergency department with mental illness to receive immediate and ongoing treatment
and other social services they need after leaving the Hospital;



Lutheran Social Services Homeless Housing: This program partners hospital care
coordinators with Lutheran Social Services staff to identify and evaluate chronically
homeless, high end hospital users and place them in transitional housing units;



Patient Navigation Program: In partnership with Sacramento Covered and Health Net,
this program assists underserved patients who are admitted to the emergency
department for non-urgent care by connecting with a primary care provider, community
clinics, and other social support services;

 76



Sacramento Community Partnerships: A collaboration with other regional health
providers and community based nonprofit organizations to address specific priorities
identified in the Community Needs Assessment and unmet healthcare needs;



Counseling Service – Poor: Psychiatric consults for patients who are uninsured and
require psychiatric medical evaluations while hospitalized and conservatorship services
to low-income patients who may lack capacity or family to help make decisions;



Cash – In Kind Donations – Poor: Cash and in-kind donations by the hospital to nonprofit
community-based organizations that provide health related services for the
underinsured, uninsured and vulnerable populations in the community;



Dignity Health Community Grants: Funding from the hospital awarded to nonprofit
organizations working to improve the health and well-being of vulnerable and
underserved populations and reduce disparities in the community;



Transitional Housing and Lodging – Poor: Provides payment for short-term room and
board in the community for patients unable to pay this expense after they are
discharged from the Hospital;



Mercy Faith & Health Partnership: A community outreach program that encourages,
supports and nurtures local faith communities to develop and sustain health ministry
programs that advocate health promotion and disease prevention in their communities;



Mercy Heart & Vascular Institute – Cardiovascular Disease Management: This program
runs CHAMP (Congestive Heart Active Management Program) that provides patients
with phone interventions, educational classes, and disease management skills after they
are discharged from the Hospital;



Professional & Medical Education – Nursing: Seminars and training for nurses focused
on the health of the broader community. This includes Hospital staff serving as
preceptors to students;



Professional & Medical Education – Other: Education for medical students, physicians,
nurses, and other healthcare professionals. This includes Hospital staff serving as
preceptors to students; and

 

Mercy Foundation – A nonprofit organization raising philanthropic support and
community awareness for the works of the Sisters of Mercy in healthcare, education,
housing for the homeless, and care for the poor and elderly.

Reproductive Health
Mercy Hospital of Folsom reported 18 inpatient discharges related to reproductive health
services.28 The table below lists reproductive services by diagnostic related group (DRG)
discharges for CY 2016.
MERCY HOSPITAL OF FOLSOM
CY 2016 REPRODUCTIVE SERVICE BY DIAGNOSTIC RELATED GROUP
Discharges
1
767-Vaginal Delivery W Sterilization &/Or D&C
8
778-Threatened Abortion
6
777-Ectopic Pregnancy
2
1
770-Abortion W D&C , Aspiration Curettage Or Hysteroctomy
1
779-Abortion W/O D&C1
1
Total Discharges:
18
Source: CY 2016 OSHPD Patient Discharge Database
1
D&C is an abbreviation for Dilation and Curettage



Out of the five diagnostic related groups, DRG 767- Vaginal Delivery with sterilization
has the most reproductive service inpatient discharges.

The following table indicates whether the Hospital performs the following women’s health
reproductive services.
MERCY HOSPITAL FOLSOM
REPRODUCTIVE SERVICES
Procedure
Caesarean delivery with sterilization
Terminate pregnancy when:
A. Placenta previa
B. Premature rupture of membranes
C. Second trimester bleeding with previable fetus
Placement of an IUD at time of other gynecological surgery
Postpartum placement of IUD
Gender affirming surgery
Emergency contraception as emergency room or inpatient
service
Ectopic pregnancy treatment with methotrexate (medication in
lieu of surgery)

Currently Performed?
(Y/N)
Yes, but only with permission following perinatology
and mission team review

Source: Dignity Health

28

Mercy Hospital of Folsom is a Catholic hospital and is subject to the Catholic ERDs

77

No
No
No
No
No
No
No
Yes, very rarely

 Analysis of Mercy Hospital of Folsom
Service Area Definition
Mercy Hospital of Folsom’s service area is comprised of 20 ZIP Codes from which 79.6% of its
inpatient discharges originated in CY 2016. Approximately 53% of Mercy Hospital of Folsom’s
discharges originated from the top four ZIP Codes, including the Cities of Folsom, El Dorado
Hills, Rancho Cordova and Shingle Springs. In CY 2016, Mercy Hospital of Folsom’s market share
in the service area was 13%.

ZIP Codes
Community
95630
Folsom
95762
El Dorado Hills
95670
Rancho Cordova
95682
Shingle Springs
95662
Orangevale
95628
Fair Oaks
95667
Placerville
95610
Citrus Heights
95827
Sacramento
95608
Carmichael
95742
Rancho Cordova
95683
Sloughhouse
95672
Rescue
95623
El Dorado
95619
Diamond Springs
95741
Rancho Cordova
95709
Camino
95655
Mather
95763
Folsom
95613
Coloma
Subtotal
Other ZIPs
Total Discharges

MERCY HOSPITAL OF FOLSOM
PATIENT ORIGIN CY 2016
Total
% of
Cumulative %
Discharges
Discharges
of Discharges
1,598
23.0%
23.0%
820
11.8%
34.9%
692
10.0%
44.8%
547
7.9%
52.7%
479
6.9%
59.6%
353
5.1%
64.7%
183
2.6%
67.3%
168
2.4%
69.8%
140
2.0%
71.8%
133
1.9%
73.7%
117
1.7%
75.4%
91
1.3%
76.7%
77
1.1%
77.8%
29
0.4%
78.2%
20
0.3%
78.5%
18
0.3%
78.8%
18
0.3%
79.0%
18
0.3%
79.3%
16
0.2%
79.5%
3
0.0%
79.6%
5,520
79.6%
79.6%
1,417
20.4%
100%
6,937
100%

Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

78

Total Area
Discharges
4,558
2,470
5,180
2,742
2,951
3,751
4,207
4,273
2,093
6,429
825
512
396
522
638
108
509
280
81
44
42,569

Market
Share
35.1%
33.2%
13.4%
19.9%
16.2%
9.4%
4.3%
3.9%
6.7%
2.1%
14.2%
17.8%
19.4%
5.6%
3.1%
16.7%
3.5%
6.4%
19.8%
6.8%
13.0%

 Service Area Map
Mercy Hospital of Folsom’s service area has approximately 494,000 residents. There are three
other hospitals located within Mercy Hospital of Folsom’s service area: Marshall Medical
Center, Vibra Hospital of Sacramento, and Mercy San Juan Medical Center. There are 11 other
hospitals located within approximately 30 miles from Mercy Hospital of Folsom. Mercy San Juan
Medical Center is the inpatient market share leader in the service area.

79

 Hospital Market Share
The table below provides the market share of inpatient discharges by individual hospital within
Mercy Hospital of Folsom’s service area from CY 2013 to CY 2016.
MERCY HOSPITAL OF FOLSOM
MARKET SHARE BY HOSPITAL CY 2013 - CY 2016
Hospital
CY 2013 CY 2014 CY 2015 CY 2016 Trend
Mercy San Juan Medical Center
18.4%
19.0%
17.6%
15.5%
↘
Kaiser Foundation Hospital - Roseville
13.3%
13.6%
14.1%
15.1%
↗
Mercy Hospital of Folsom
12.0%
12.3%
12.9%
13.0%
↗
Marshall Medical Center
9.5%
9.2%
9.9%
10.0%
↗
University of California Davis Medical Center
9.2%
9.0%
8.7%
8.9%
→
Sutter Medical Center, Sacramento
6.1%
5.7%
4.6%
7.9%
↗
Sutter Roseville Medical Center
6.4%
6.3%
6.1%
6.8%
↗
Kaiser Foundation Hospital - Sacramento
5.3%
5.1%
5.2%
5.5%
↗
Mercy General Hospital
5.1%
5.1%
4.9%
4.2%
↘
Kaiser Foundation Hospital - South Sacramento
1.1%
1.2%
1.3%
1.5%
↗
Sierra Vista Hospital
1.6%
1.4%
1.5%
1.4%
→
Heritage Oaks Hospital
1.5%
1.4%
1.4%
1.4%
→
Methodist Hospital of Sacramento
0.9%
1.0%
1.2%
1.2%
→
Sutter Center for Psychiatry
1.1%
1.0%
0.9%
0.8%
↘
UCSF Medical Center
0.5%
0.6%
0.6%
0.7%
→
Telecare El Dorado County P.H.F.
0.5%
0.6%
0.3%
0.4%
→
Woodland Memorial Hospital
0.2%
0.2%
0.3%
0.4%
↗
St. Joseph's Behavioral Health Center
0.4%
0.5%
0.5%
0.4%
→
Stanford Health Care
0.3%
0.3%
0.3%
0.2%
→
All Other
6.6%
6.6%
7.7%
4.5%
↘
Total Percentage
100%
100%
100%
100%
Total Discharges
42,271 41,915 42,133 42,569
↗
Source: OSHPD Discharge Database, CY 2013 - CY 2016
Note: Excludes normal newborns

80



The number of inpatient discharges (42,569) has remained relatively stable between CY
2013 and CY 2016;



From CY 2013 to CY 2016, Mercy Hospital of Folsom has consistently ranked third in
terms of overall market share for the service area based on inpatient discharges (13% in
CY 2016); and



Mercy San Juan Medical Center has the largest market share (15.5% in CY 2016).

 Market Share by Payer Type
The following table provides the service area’s hospital inpatient market share by payer type as
reported by OSHPD for CY 2016.

Marshall Medical Center

University Of California Davis Medical Center

Sutter Medical Center, Sacramento

Sutter Roseville Medical
Center

Kaiser Foundation Hospital - Sacramento

42,569

Mercy Hospital Of Folsom

Total
Discharges
18,314
13,887
8,945
1,061
362

Kaiser Foundation Hospital Roseville

Payer Type
Medicare
Private Coverage
Medi-Cal
All Other
Self-Pay
Total Percentage
Total Discharges

Mercy San Juan Medical Center

MERCY HOSPITAL OF FOLSOM
HOSPITAL MARKET SHARE BY PAYER TYPE CY 2016

18.4%
7.9%
21.9%
10.7%
10.8%
15.5%
6,582

13.8%
23.4%
6.3%
1.1%
14.9%
15.1%
6,414

14.4%
13.6%
9.0%
12.1%
14.9%
13.0%
5,520

13.0%
5.6%
11.8%
3.1%
3.0%
10.0%
4,262

7.3%
10.1%
10.5%
10.7%
0.8%
8.9%
3,802

5.8%
7.1%
11.8%
22.6%
13.8%
7.9%
3,384

7.1%
7.3%
5.0%
8.3%
16.0%
6.8%
2,915

7.9%
4.8%
2.5%
0.6%
5.2%
5.5%
2,356

All
Others
12.3%
20.1%
21.1%
30.8%
20.4%
17.2%
7,334

Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

81



The largest payer type for inpatient discharges is Medicare with 18,314 discharges
(43%), Private Coverage with 13,887 inpatient discharges (33%), and Medi-Cal with
8,945 inpatient discharges (21%);



Mercy San Juan Medical Center is the market share leader for Medicare (18%) and
Medi-Cal (22%);



Kaiser Foundation Hospital Roseville is the market share leader for Private Coverage
(23%); and



Sutter Roseville Medical Center is the market share leader for Self-Pay (16%).

Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%

 Market Share by Service Line
The following table provides the service area’s inpatient market share by service line for CY
2016.

82

Kaiser Foundation Hospital - Roseville

Mercy Hospital Of Folsom

Marshall Medical Center

University Of California Davis Medical Center

Sutter Medical Center, Sacramento

Sutter Roseville Medical Center

Kaiser Foundation Hospital - Sacramento

Total
Service Line
Discharges
General Medicine
13,004
Obstetrics
5,194
Cardiac Services
4,299
General Surgery
3,965
Orthopedics
3,948
Behavioral Health
2,891
Neonatology
2,052
Neurology
1,900
Oncology/Hematology (Medical)
1,195
Spine
957
Other
736
Urology
539
Vascular Services
479
ENT
390
Neurosurgery
377
Gynecology
372
Rehabilitation
167
No-match-found
74
Total Percentage
Total Discharges
42,569
Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

Mercy San Juan Medical Center

MERCY HOSPITAL OF FOLSOM
HOSPITAL MARKET SHARE BY SERVICE LINE CY 2016

19.1%
10.8%
19.0%
15.5%
13.1%
3.0%
10.1%
21.3%
14.4%
6.5%
28.1%
16.1%
25.9%
13.1%
23.6%
22.3%
0.0%
9.5%
15.5%
6,582

13.5%
30.3%
13.2%
11.9%
17.2%
0.7%
37.4%
10.6%
11.5%
2.5%
5.0%
8.7%
14.4%
9.7%
1.3%
3.5%
0.0%
5.4%
15.1%
6,414

16.8%
13.1%
11.7%
17.8%
12.8%
2.1%
7.1%
15.3%
9.9%
9.1%
6.0%
14.1%
5.8%
7.7%
0.3%
13.2%
0.0%
5.4%
13.0%
5,520

14.3%
7.4%
9.5%
8.8%
9.8%
1.9%
11.3%
9.5%
12.1%
2.5%
6.8%
12.6%
5.8%
7.2%
0.3%
5.9%
18.0%
14.9%
10.0%
4,262

9.1%
5.2%
8.2%
11.7%
9.0%
1.2%
7.0%
9.3%
18.2%
14.0%
20.7%
13.5%
9.0%
24.4%
14.3%
8.6%
3.6%
17.6%
8.9%
3,802

5.2%
17.9%
9.3%
5.3%
6.3%
0.6%
12.9%
6.4%
11.2%
12.2%
2.0%
7.1%
18.0%
7.9%
14.3%
9.9%
0.0%
14.9%
7.9%
3,384

7.3%
7.4%
5.9%
7.2%
7.8%
0.6%
6.9%
8.1%
6.1%
11.4%
11.0%
9.1%
6.5%
7.2%
4.2%
9.7%
0.0%
2.7%
6.8%
2,913

6.8%
0.0%
5.5%
6.9%
8.0%
0.7%
0.0%
8.5%
4.2%
21.3%
4.1%
3.0%
5.8%
4.1%
21.2%
8.3%
0.0%
5.4%
5.5%
2,356

All
Others
7.8%
7.9%
17.9%
14.9%
16.1%
89.2%
7.5%
11.1%
12.5%
20.5%
16.3%
15.8%
8.8%
18.7%
20.4%
18.5%
78.4%
24.3%
17.2%
7,336



Mercy Hospital of Folsom is a service line leader in its service area for general surgery
(17.8%);



Mercy San Juan Medical Center is the service area service line leader for nine service
lines, ranging from a market share percentage of behavioral health (3%) to vascular
services (25.9%); and



Kaiser Foundation Hospital Roseville is the service area service line leader in three
service lines – obstetrics (30.3%), orthopedics (17.2%), and neonatology (37.4%).

Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%

 83

JD Healthcare ViZientm

Market Share by ZIP Code
The following table illustrates service area’s hospital market share by ZIP Code for CY 2016.

Sutter Medical Center, Sacramento

Sutter Roseville Medical Center

Kaiser Foundation Hospital - Sacramento

42,569

University Of California Davis Medical
Center

6,429
5,180
4,558
4,273
4,207
3,751
2,951
2,742
2,470
2,093
825
638
522
512
509
396
280
108
81
44

Marshall Medical Center

95608
Carmichael
95670
Rancho Cordova
95630
Folsom
95610
Citrus Heights
95667
Placerville
95628
Fair Oaks
95662
Orangevale
95682
Shingle Springs
95762
El Dorado Hills
95827
Sacramento
95742
Rancho Cordova
95619
Diamond Springs
95623
El Dorado
95683
Sloughhouse
95709
Camino
95672
Rescue
95655
Mather
95741
Rancho Cordova
95763
Folsom
95613
Coloma
Total Percentage
Total Discharges

Total
Discharges

Mercy Hospital Of Folsom

Community

Kaiser Foundation Hospital - Roseville

ZIP Code

Mercy San Juan Medical Center

MERCY HOSPITAL OF FOLSOM
HOSPITAL MARKET SHARE BY ZIP CODE CY 2016

All
Others

35.2%
13.8%
6.8%
27.1%
1.4%
28.5%
16.8%
4.0%
5.1%
6.4%
5.1%
0.9%
1.1%
5.9%
1.2%
4.8%
6.8%
10.2%
6.2%
2.3%
15.5%
6,582

9.7%
10.4%
19.4%
20.4%
12.0%
18.6%
23.9%
15.0%
18.8%
7.9%
20.2%
14.6%
12.8%
8.4%
3.3%
20.5%
19.6%
8.3%
16.0%
9.1%
15.1%
6,414

2.1%
13.4%
35.1%
3.9%
4.3%
9.4%
16.2%
19.9%
33.2%
6.7%
14.2%
3.1%
5.6%
17.8%
3.5%
19.4%
6.4%
16.7%
19.8%
6.8%
13.0%
5,520

0.1%
0.2%
0.4%
0.0%
54.9%
0.2%
0.2%
28.3%
3.6%
0.0%
0.1%
56.6%
48.7%
0.0%
64.8%
16.7%
0.4%
0.0%
4.9%
43.2%
10.0%
4,262

8.0%
16.4%
7.6%
6.1%
5.0%
7.5%
5.7%
6.6%
8.4%
18.8%
16.5%
4.4%
7.1%
10.4%
4.9%
8.1%
13.6%
18.5%
17.3%
9.1%
8.9%
3,802

11.0%
12.6%
4.3%
5.9%
5.9%
5.9%
4.4%
5.4%
5.4%
16.0%
10.2%
8.8%
7.5%
14.3%
9.2%
4.3%
12.1%
3.7%
2.5%
4.5%
7.9%
3,384

4.9%
3.8%
6.4%
18.9%
2.1%
10.5%
16.7%
2.9%
4.6%
1.5%
4.1%
1.6%
3.1%
1.4%
2.0%
3.5%
3.2%
2.8%
7.4%
0.0%
6.8%
2,915

11.8%
9.2%
2.3%
2.3%
2.5%
4.2%
2.6%
2.6%
2.9%
12.0%
6.4%
2.7%
1.9%
8.4%
1.0%
3.5%
11.1%
12.0%
1.2%
2.3%
5.5%
2,356

17.3%
20.2%
17.7%
15.4%
11.9%
15.2%
13.5%
15.2%
18.0%
30.8%
23.2%
7.4%
12.3%
33.6%
10.0%
19.2%
26.8%
27.8%
24.7%
22.7%
17.2%
7,334

Total

100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%

Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

84



Mercy Hospital of Folsom is the inpatient market share leader in four of the 20 ZIP
Codes;



Marshall Medical Center is the inpatient market share leader in six of the ZIP Codes; and



Kaiser Foundation Hospital Roseville is the inpatient market share leader in a different
four ZIP Codes.

 Profile of Mercy General Hospital
Overview
Mercy General Hospital is a general acute care hospital located at 4001 J Street in Sacramento.
The Hospital was established by the Sisters of Mercy in 1925 and was initially named Mercy
Hospital before being renamed to Mercy General Hospital.
Today, Mercy General Hospital offers a range of services including: obstetrics, critical care
medicine, and cardiovascular care. The hospital has 18 surgical operating rooms and a “basic”
emergency department with 20 emergency treatment stations. According to Mercy General
Hospital’s current hospital license, the Hospital is licensed for 419 beds as shown below.
MERCY GENERAL HOSPITAL
LICENSED BED DISTRIBUTION 2018
Licensed Bed Type
General Acute Care Beds
Rehabilitation
Perinatal
Intensive Care
Unspecified General Acute Care
Total General Acute Care Beds
Total Licensed Beds
1

85

2018 Hospital License

Number of
Beds1
30
17
46
326
419
419

 Key Statistics
For FY 2017 Mercy General Hospital reported 15,535 inpatient discharges, 66,071 patient days,
resulting in an average daily census of 181 patients (approximately 43% occupancy).
MERCY GENERAL HOSPITAL
KEY STATISTICS FY 2015 - FY 20171
FY 2015
Inpatient Discharges
16,160
Licensed Beds
394
Patient Days
75,409
Average Daily Census
207
Occupancy
52.4%
Average Length of Stay
4.7
Cardiac Catheterization Procedures
5,718
Emergency Service Visits
44,309
Total Live Births
1,824

FY 2016
15,927
419
67,362
185
44.0%
4.2
5,112
46,347
926

FY 2017
15,535
419
66,071
181
43.2%
4.3
4,945
45,026
1,088

Sources: OSHPD Disclosure Reports, FY 2015 - FY 2017
1 FY 2015 and FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 data is from unaudited.

86



Between FY 2015 and FY 2017, inpatient discharges have decreased by 4%, while patient
days decreased by 12%;



In FY 2017, 45,026 emergency service visits were reported, a 2% increase from FY 2015;



In FY 2017, 4,945 cardiac catheterization procedures were reported; and



Between FY 2013 and FY 2017, total live births decreased by 40% with an average of
1,279 live births annually.

 Patient Utilization Trends
The following table shows FY 2013 – FY 2017 volume trends Mercy General Hospital.
MERCY GENERAL HOSPITAL
SERVICE VOLUMES FY 2013 - FY 2017
PATIENT DAYS
FY 2013
FY 2014
FY 2015
FY 2016
Medical/Surgical2
47,083
45,624
49,264
48,697
Intensive Care
10,444
10,093
10,441
9,885
Obstetrics
5,555
5,979
8,597
2,533
Physical Rehabilitation Care
6,781
7,161
7,107
6,247
Skilled Nursing
6,335
Total
76,198
68,857
75,409
67,362
DISCHARGES
Medical/Surgical2
12,800
12,580
10,557
11,345
Intensive Care
406
391
2,238
3,138
Obstetrics
2,536
2,531
1,842
940
Physical Rehabilitation Care
510
535
1,523
504
Skilled Nursing
468
Total
16,720
16,037
16,160
15,927
AVERAGE LENGTH OF STAY
Medical/Surgical2
3.7
3.6
4.7
4.3
Intensive Care
25.7
25.8
4.7
3.2
Obstetrics
2.2
2.4
4.7
2.7
Physical Rehabilitation Care
13.3
13.4
4.7
12.4
Skilled Nursing
13.5
Total
4.6
4.3
4.7
4.2
AVERAGE DAILY CENSUS
Medical/Surgical2
129.0
125.0
135.0
133.4
Intensive Care
28.6
27.7
28.6
27.1
Obstetrics
15.2
16.4
23.6
6.9
Physical Rehabilitation Care
18.6
19.6
19.5
17.1
Skilled Nursing
17.4
Total
209
189
207
185
OTHER SERVICES
Inpatient Surgeries
3,390
3,136
3,149
3,666
Outpatient Surgeries
9,666
10,112
10,173
10,063
Emergency Services Visits
32,931
34,071
36,998
38,931
Total Live Births
2,123
2,086
1,824
926
Sources: OSHPD Disclosure Reports, FY 2013 - FY 2017
1 FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.
2
Includes Definitive Observation Beds

FY 20171
47,942
9,260
2,853
6,016
66,071
8,830
4,040
2,216
449
15,535
5.4
2.3
1.3
13.4
4.3
131.3
25.4
7.8
16.5
181
3,538
3,601
38,047
1,088

A review of Mercy General Hospital’s historical utilization trends between FY 2013 and FY 2017
supports the following conclusions:

87



Total patient days have decreased by 13%;



Inpatient discharges have decreased by 7%;



The average daily census has decreased by 13% from 209 patients in FY 2013 to 181
patients in FY 2017; and



Emergency service visits increased by 15% to 38,047 visits in FY 2017.

 Financial Profile
Over the last five fiscal years, Mercy General Hospital has had positive, yet declining net income
ranging from $67.6 million in FY 2013 to $48.0 million in FY 2017. Between FY 2013 and FY
2017, net patient revenue and total operating revenue increased by nearly 11% and 10%,
respectively. Over that same period, the Hospital’s operating expenses increased by 12% from
$487.4 million in FY 2013 to $547.3 million in FY 2017. Other operating revenue decreased by
44% over the five-year period from $6.1 million to $3.4 million.
The Hospital’s current ratio has fluctuated over the last five years but increased from 3.67 in FY
2013 to 3.90 in FY 2017. The California average in FY 2016 was 1.56. Mercy General Hospital’s
percentage of bad debt is 0.5% and higher than the statewide average of 0.8%.
MERCY GENERAL HOSPITAL
FINANCIAL AND RATIO ANALYSIS FY 2013 - FY 2017
Patient Days
Discharges
ALOS
Net Patient Revenue
Other Operating Revenue
Total Operating Revenue
Operating Expenses
Net from Operations
Net Non-Operating Revenues and Expenses
Net Income

FY 2013

FY 2014

FY 2015

FY 2016

FY 20171

76,198
16,720
4.6

68,857
16,037
4.3

75,409
16,160
4.7

67,362
15,927
4.2

66,071
15,535
4.3

-

$532,788,097
$6,137,416
$538,925,513
$487,409,207
$51,516,306
$16,118,977
$67,635,283

$495,294,534
$5,598,699
$500,893,233
$464,928,942
$35,964,291
$13,534,538
$49,498,829

$597,436,892
$3,860,342
$601,297,234
$552,647,283
$48,649,951
$590,049
$49,240,000

$568,817,857
$5,485,504
$574,303,361
$542,343,880
$31,959,481
($4,296,809)
$27,662,672

$588,823,420
$3,447,242
$592,270,662
$547,276,097
$44,994,565
$2,985,320
$47,979,885

3.35
42.7
0.8%
8.09%

3.37
45.4
0.5%
5.56%

3.90
45.0
0.5%
7.60%

2016 California
Average2
1.56
57.1
0.8%
2.74%

Current Ratio
3.67
4.17
Days in A/R
43.8
51.7
Bad Debt Rate
1.5%
1.2%
Operating Margin
9.56%
7.18%
Source: OSHPD Disclosure Reports, FY 2013 - FY 2017
2 FY 2017 California data was not available when the data was collected to prepare this report.

88

 Cost of Hospital Services
Mercy General Hospital’s operating cost of services includes both inpatient and outpatient care.
In FY 2017, approximately 50% of total costs were associated with Medicare, 27% with ThirdParty, and 22% with Medi-Cal.
MERCY GENERAL HOSPITAL
OPERATING EXPENSES BY PAYER CATEGORY FY 2013 - FY 2017
Operating Expenses

FY 2013
$487,409,207

FY 2014
$464,928,942

FY 2015
$552,647,283

FY 2016
$542,343,880

FY 20171
$547,276,097

Cost of Services By Payer:
Medicare
Medi-Cal
County Indigent
Third-Party
Other Indigent
All Other Payers

$224,677,100
$66,577,537
$24,756,556
$158,791,214
$4,180,079
$8,426,721

$234,452,394
$83,183,844
$10,713,398
$125,370,801
$2,554,142
$8,654,363

$279,980,192
$112,241,833
$848,142
$153,924,066
$1,433,755
$4,219,296

$275,041,565
$121,867,292
$11,598
$141,230,133
$1,509,693
$2,683,599

$273,916,497
$122,465,029
$14,840
$146,121,593
$2,351,725
$2,406,414

Source: OSHPD Disclosure Reports, FY 2013 - FY 2017
1
FY 2013 to FY 2016 Hospital data is from audited OSHPD Disclosure Reports. FY 2017 is unaudited.

Charity Care
The following table shows a comparison of charity care and bad debt for Mercy General
Hospital and all general acute care hospitals in the State of California. The five-year (FY 2013 –
FY 2017) average of charity care and bad debt, as a percentage of gross patient revenue, was
1.5% and lower than the four-year statewide average of 2.5%. According to OSHPD, “…the
determination of what is classified as charity care can be made by establishing whether or not
the patient has the ability to pay. The patient’s accounts receivable must be written off as bad
debt if the patient has the ability but is unwilling to pay off the account.”

MERCY GENERAL HOSPITAL
CHARITY CARE COMPARISON FY 2013 - FY 20171 (In Thousands)
FY 2013
FY 2014
FY 2015

FY 2016

FY 2017
CA

Hospital
CA
Hospital
CA
Gross Patient Revenue
$2,410,805
$320,382,471
$2,337,634
$338,322,364
Charity
$22,198
$6,563,487
$19,851
$5,113,965
Bad Debt
$35,138
$5,891,632
$27,658
$4,365,936
Total Charity & Bad Debt
$57,337
$12,455,119
$47,509
$9,479,902
Charity Care as a % of Gross Patient Revenue
0.9%
2.0%
0.8%
1.5%
Bad Debt as a % of Gross Patient Revenue
1.5%
1.8%
1.2%
1.3%
Total as a % of Gross Patient Revenue
2.4%
3.9%
2.0%
2.8%
Uncompensated Care
Cost to Charge Ratio¹
20.0%
24.5%
19.6%
23.6%
Charity
$4,431
$1,608,711
$3,901
$1,207,919
Bad Debt
$7,015
$1,444,039
$5,435
$1,031,234
Total
$11,446
$3,052,750
$9,335
$2,239,153
Source: OSHPD Disclosure Reports FY 2013 - FY 2017
1
FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 data is from unaudited.
2
FY 2017 California data was not available when the data was collected to prepare this report.

89

Hospital
$2,581,413
$10,335
$21,519
$31,854
0.4%
0.8%
1.2%

CA
$365,501,463
$3,441,227
$3,262,642
$6,703,869
0.9%
0.9%
1.8%

Hospital
$2,599,956
$10,026
$11,946
$21,972
0.4%
0.5%
0.8%

CA
$396,427,743
$3,457,868
$3,108,971
$6,566,839
0.9%
0.8%
1.7%

Hospital
$2,691,063
$13,688
$13,120
$26,808
0.5%
0.5%
1.0%

2

21.3%
$2,197
$4,575
$6,772

24.1%
$828,647
$785,644
$1,614,292

20.6%
$2,070
$2,467
$4,537

23.8%
$822,627
$739,624
$1,562,251

20.2%
$2,766
$2,651
$5,418

-

-

 The following table shows Mercy General Hospital historical costs for charity care as reported
to OSHPD. Mercy General Hospital’s charity care costs have decreased from $4.4 million in FY
2013 to $2.8 million in FY 2017. The average cost of charity care for the last five-year period
was approximately $3.1 million, while for the three-year average the cost of charity care was
$3.5 million.

MERCY GENERAL HOSPITAL
COST OF CHARITY CARE FY 2013 - FY 20171
Charity Care
Charges
$13,687,655
$10,025,943
$10,335,206
$19,850,800
$22,198,242

Year
FY 2017
FY 2016
FY 2015
FY 2014
FY 2013
FY 2015 - FY 2017 Average
FY 2013 - FY 2017 Average

Cost to
Charge Ratio
20.2%
20.6%
21.3%
19.6%
20.0%

Cost of Charity
Care to the
Hospital
$2,766,097
$2,070,232
$2,197,179
$3,900,556
$4,431,460
$3,509,732
$3,073,105

Source: OSHPD Disclosure Reports FY 2013 - FY 2017
1
FY 2013 to FY 2016 data is from audited OSHPD Disclosure Reports whereas FY 2017 is from unaudited.

In the application to the California Attorney General, Dignity Health reported the following
combined distribution of charity care costs by inpatient, outpatient, and emergency room costs.
MERCY GENERAL HOSPITAL
COST OF CHARITY CARE BY SERVICE FY 2013 - FY 2017
Emergency
Inpatient
Outpatient
Room
FY 2017:
Cost of Charity
Visits/Discharges
FY 2016:
Cost of Charity
Visits/Discharges
FY 2015:
Cost of Charity
Visits/Discharges
FY 2014:
Cost of Charity
Visits/Discharges
FY 2013:
Cost of Charity
Visits/Discharges

Total Costs

$1,015,723
42

$1,076,477
364

$276,610
335

$2,368,810

$871,404
46

$650,043
287

$183,014
280

$1,704,461

$1,678,591
87

$888,731
327

$218,442
332

$2,785,764

$2,754,395
151

$896,126
351

$223,252
319

$3,873,773

$2,549,844
142

$924,406
421

$240,285
372

$3,714,535

Source: Dignity Health

Note that these totals are different than what Dignity Health reported to OSHPD. However,
after discussion with JD Healthcare Inc. and Vizient Inc., Dignity Health has acknowledged that
an error was made in its calculation of charity care costs. Dignity Health has stated that they
will comply with the charity care cost amounts determined in the manner described above.

90

 Community Benefit Services
In the last five years, Mercy General Hospital has provided significant community benefit
services. As shown in the table below, the average annual cost of community benefit services
over the three years has been $6.7 million. The average annual cost of community benefit
services over the last five years has been $7.2 million.
MERCY GENERAL HOSPITAL
COMMUNITY BENEFIT SERVICES FY 2013 - FY 2017

Community Benefit Programs
Benefits for Living in Poverty
Benefits for Broader Community
Totals
Medi-Cal Provider Fee CHFT Grant Expense
Adjusted Totals
Source: Dignity Health

FY 2013
$6,933,716
$2,844,527
$9,778,243
($818,959)
$8,959,284

FY 2014
$5,207,309
$2,449,192
$7,656,501
($281,078)
$7,375,423

FY 2015
$6,101,918
$2,453,653
$8,555,571
($989,008)
$7,566,563

FY 2016
$5,743,604
$2,551,331
$8,294,935
($493,127)
$7,801,808

FY 2017
$3,157,213
$1,875,866
$5,033,079
($413,892)
$4,619,187

FY 2015 –
FY 2017
Average
$5,000,912
$2,293,617
$7,294,528
$6,662,519

● The Hospital’s five-year average cost of community benefit services for persons living in
poverty is $5.4 million per year;
● The Hospital’s five-year average cost of community benefit services for the broader
community is $2.4 million per year; and
● Over the five-year period, the Hospital’s adjusted total cost of community benefit
services decreased from $9.0 million in FY 2013 to $4.6 million in FY 2017.

91

FY 2013 –
FY 2017
Average
$5,428,752
$2,434,914
$7,863,666
$7,164,131

 The Hospital’s community benefit services over the past five fiscal years included the following
programs over $10,000 in cost in FY 2017:
MERCY GENERAL HOSPITAL
COST OF COMMUNITY BENEFIT SERVICES FY 2013 - FY 2017
Services over $10,000 in cost in FY 2017:
FY 2013
FY 2014
FY 2015
Catholic School Health Nurse
$18,179
$21,218
$20,956
Chronic Disease Self-Management Program
$27,443
$17,904
$20,090
El Hogar Refer Net
Lutheran Social Services Homeless Housing
Mercy Heart and Vascular Institute $154,307
$111,325
$369,423
Cardiac Conditioning Charity Care
Patient Navigator Program
$106,355
$115,679
Sacramento Community Partnerships
$80,308
Wellspace Interim Care Program
Counseling Service-Poor
$204,144
$324,503
$247,961
House of Mercy
$58,858
$51,907
-$23,412
Mercy Family Health Center (Family
$981,104
$677,050
$512,614
Practice Residency)
Mercy Clinic Loaves & Fishes
$469,756
$265,544
$103,839
Renal Dialysis Service
Cash-In Kind Donations-Poor
$40,079
$31,220
$183,105
Dignity Health Community Grants
$247,815
$258,639
$246,833
Sacramento Service Area Partnerships
$177,290
$184,965
$85,444
Transitional Housing and Lodging -Poor
$868
$1,206
$610
Mercy Faith & Health Partnerships
$24,621
$36,254
$31,747
Mercy Heart and Vascular Institute $13,857
$10,831
$12,976
American Heart Association Heart Walk
Mercy Heart and Vascular Institute $1,531,089 $1,734,351 $1,294,361
Cardiovascular Disease Management
Mercy Heart and Vascular Institute $47,594
$94,787
$31,885
Education - Other
Professional & Medical Education - Nursing
$82,166
$65,543
$770,993
Professional & Medical Education - Other
Mercy Foundation Support
$814,208
$777,338
$834,704

FY 2016
$17,248
$17,871
-

FY 2017
$16,001
$24,595
$41,497
$54,000

$455,362

$589,080

$57,070
$137,701
$329,017
-$25,632

$17,152
$49,680
$33,564
$493,402
-$20,075

$520,246

$512,599

$96,375
$51,463
$236,246
$12,995
$33,608

$72,587
$55,414
$44,763
$280,457
$12,600
$22,547
$36,516

$9,397

$46,942

$959,928

$393,894

$58,904

$60,854

$837,748
$405,086
$772,759

$724,570
$377,206
$740,527

Source: Dignity Health

92



Catholic School Health Nurse: The hospital sponsors a nurse to provide health care and
screenings to low income children at five Catholic schools;



Chronic Disease Self-Management Program: The program offers weekly workshops for
six weeks on diabetes in clinical and community settings as well as on other chronic
health problems;



El Hogar Refer Net: In collaboration with the community based nonprofit mental health
provider, El Hogar, this program provides a process for patients admitted to the
emergency department with mental illness to receive immediate and ongoing treatment
and other social services they need after leaving the Hospital;

 93



Lutheran Social Services Homeless Housing: This program partners hospital care
coordinators with Lutheran Social Services staff to identify and evaluate chronically
homeless, high end hospital users and place them in transitional housing units;



Mercy Heart and Vascular Institute - Cardiac Conditioning Charity Care: Provides
education classes and materials, and expedites referrals to outpatient programs for
uninsured patients;



Patient Navigation Program: In partnership with Sacramento Covered and Health Net,
this program assists underserved patients who are admitted to the emergency
department for non-urgent care by connecting with a primary care provider, community
clinics, and other social support services;



Sacramento Community Partnerships: A collaboration with other regional health
providers and community based nonprofit organizations to address specific priorities
identified in the Community Needs Assessment and unmet healthcare needs;



Wellspace Interim Care Program: A collaboration between other Dignity Health hospitals
and health systems in the region, Sacramento County and Federally Qualified Health
Center, WellSpace Health, to provide shelter and treatment for homeless patients with
physical or mental health disorders. The program also provides case management
services to connect participants with outpatient services and community resources;



Counseling Service – Poor: Psychiatric consults for patients who are uninsured and
require psychiatric medical evaluations while hospitalized and conservatorship services
to low-income patients who may lack capacity or family to help make decisions;



House of Mercy: A program for families who cannot afford hotel accommodations while
their family member is receiving care or for out of area patients who are recovering or
receiving ongoing treatment at the Hospital;



Mercy Family Health Center (Family Practice Residency): Resident physicians are
sponsored by the hospital to provide primary health care services to the poor and
underinsured at the Mercy Family Health Center located on the campus of Methodist
Hospital;



Mercy Clinic Loaves & Fishes: A collaboration between The Loaves & Fishes
organization, County of Sacramento, and Mercy General to provide free episodic and
urgent health care to the homeless people;

 94



Renal Dialysis Services: The Care Coordination Department pays for dialysis services for
the underserved;



Cash – In Kind Donations – Poor: Cash and in-kind donations by the Hospital to nonprofit
community-based organizations that provide health related services for the
underinsured, uninsured and vulnerable populations in the community;



Dignity Health Community Grants: Funding from the Hospital awarded to nonprofit
organizations working to improve the health and well-being of vulnerable and
underserved populations and reduce disparities in the community;



Sacramento Service Area Partnerships/Donations – Poor: A collaboration with other
regional health providers and community based nonprofit organizations to address
specific priorities identified in the Community Needs Assessment and unmet healthcare
needs;



Transitional Housing and Lodging – Poor: Provides payment for short-term room and
board in the community for patients unable to pay this expense after they are
discharged from the Hospital;



Mercy Faith & Health Partnership: A community outreach program that encourages,
supports and nurtures local faith communities to develop and sustain health ministry
programs that advocate health promotion and disease prevention in their communities;



Mercy Heart and Vascular Institute – American Heart Association Heart Walk: Hospital
support for the American Heart Association’s Heart Walk;



Mercy Heart & Vascular Institute – Cardiovascular Disease Management: This program
runs CHAMP (Congestive Heart Active Management Program) that provides patients
with phone interventions, educational classes, and disease management skills after they
are discharged from the Hospital;



Mercy Heart and Vascular Institute – Education – Other: Provides free informational
materials and educational classes on how to manage heart failure;



Professional & Medical Education – Nursing: Seminars and training for nurses focused
on the health of the broader community. This includes Hospital staff serving as
preceptors to students;

 

Professional & Medical Education – Other: Education for medical students, physicians,
nurses, and other healthcare professionals. This includes Hospital staff serving as
preceptors to students; and



Mercy Foundation – A nonprofit organization raising philanthropic support and
community awareness for the works of the Sisters of Mercy in healthcare, education,
housing for the homeless, and care for the poor and elderly.

Reproductive Health
Mercy General Hospital reported 27 inpatient discharges related to reproductive health
services29. The table below lists all reproductive services by diagnostic related group discharges
(DRG) for CY 2016.
MERCY GENERAL HOSPITAL
CY 2016 REPRODUCTIVE SERVICE BY DIAGNOSTIC RELATED GROUP
777-Ectopic Pregnancy
767-Vaginal Delivery W Sterilization &/Or D&C1
778-Threatened Abortion
779-Abortion W/O D&C1
770-Abortion W D&C1, Aspiration Curettage or Hysteroctomy
Total Discharges:

Discharges
10
5
5
5
2
27

Source: CY 2016 OSHPD Patient Discharge Database
1
D&C is an abbreviation for Dilation and Curettage

● Out of the five diagnostic related groups, 777-Ectopic Pregnancy has the highest number
of reproductive service inpatient discharges.

29

Mercy General Hospital is a Catholic hospital and is subject to the Catholic ERDs

95

 The following table indicates whether the Hospital performs the following women’s health
reproductive services.

MERCY GENERAL HOSPITAL
REPRODUCTIVE SERVICES
Procedure
Caesarean delivery with sterilization
Terminate pregnancy when:
A. Placenta previa
B. Premature rupture of membranes
C. Second trimester bleeding with previable fetus
Placement of an IUD at time of other gynecological surgery
Postpartum placement of IUD
Gender affirming surgery
Emergency contraception as emergency room or inpatient service
Ectopic pregnancy treatment with methotrexate (medication in lieu of surgery)
Source: Dignity Health

96

Currently Performed?
(Y/N)
No
No
No
No
No
No
No
No
Yes

 Analysis of Mercy General Hospital’s Service Area
Service Area Definition
Mercy General Hospital’s service area is comprised of 45 ZIP Codes from which 78.4% of its
inpatient discharges originated in 2016. Approximately 50% Mercy General Hospital’s
discharges originated from the top 17 ZIP codes. In 2016, Mercy General Hospital’s market
share in the service area was 8.5%.

ZIP Codes
Community
95823
Sacramento
95838
Sacramento
95822
Sacramento
95825
Sacramento
95815
Sacramento
95820
Sacramento
95828
Sacramento
95826
Sacramento
95831
Sacramento
95833
Sacramento
95824
Sacramento
95821
Sacramento
95691
West Sacramento
95758
Elk Grove
95835
Sacramento
95670
Rancho Cordova
95624
Elk Grove
95834
Sacramento
95864
Sacramento
95608
Carmichael
95819
Sacramento
95827
Sacramento
95818
Sacramento
95816
Sacramento
95630
Folsom
95814
Sacramento
95660
North Highlands
95817
Sacramento
95605
West Sacramento
95757
Elk Grove
95628
Fair Oaks
95673
Rio Linda
95621
Citrus Heights
95610
Citrus Heights
95811
Sacramento
95829
Sacramento
95842
Sacramento
95662
Orangevale
95832
Sacramento
95841
Sacramento
95655
Mather
95612
Clarksburg
95865
Sacramento
95652
Mcclellan
95853
Sacramento
Subtotal
Other ZIPs
Total Discharges
Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

97

MERCY GENERAL HOSPITAL
PATIENT ORIGIN CY 2016
Total
Discharges
% of Discharges
635
4.4%
580
4.1%
548
3.8%
535
3.7%
506
3.5%
483
3.4%
443
3.1%
422
3.0%
376
2.6%
374
2.6%
365
2.6%
359
2.5%
337
2.4%
317
2.2%
307
2.1%
304
2.1%
289
2.0%
284
2.0%
284
2.0%
280
2.0%
268
1.9%
255
1.8%
223
1.6%
221
1.5%
205
1.4%
193
1.4%
177
1.2%
177
1.2%
166
1.2%
160
1.1%
132
0.9%
129
0.9%
127
0.9%
123
0.9%
122
0.9%
115
0.8%
108
0.8%
98
0.7%
72
0.5%
54
0.4%
14
0.1%
9
0.1%
6
0.0%
5
0.0%
5
0.0%
11,192
78.4%
3,088
21.6%
14,280
100.0%

Cum % of
Discharges
4.4%
8.5%
12.3%
16.1%
19.6%
23.0%
26.1%
29.1%
31.7%
34.3%
36.9%
39.4%
41.8%
44.0%
46.1%
48.3%
50.3%
52.3%
54.3%
56.2%
58.1%
59.9%
61.4%
63.0%
64.4%
65.8%
67.0%
68.3%
69.4%
70.5%
71.5%
72.4%
73.3%
74.1%
75.0%
75.8%
76.5%
77.2%
77.7%
78.1%
78.2%
78.3%
78.3%
78.3%
78.4%
78.4%
100%

Total Area
Discharges
8,524
4,120
4,744
3,519
3,433
4,267
5,823
3,195
3,349
3,296
3,340
3,881
3,214
4,321
2,456
5,180
4,638
2,370
1,821
6,429
1,261
2,093
1,717
1,604
4,558
1,355
4,169
1,705
1,446
2,742
3,751
1,819
4,455
4,273
959
2,001
3,286
2,951
1,205
2,381
280
116
48
69
16
132,180

Market
Share
7.4%
14.1%
11.6%
15.2%
14.7%
11.3%
7.6%
13.2%
11.2%
11.3%
10.9%
9.3%
10.5%
7.3%
12.5%
5.9%
6.2%
12.0%
15.6%
4.4%
21.3%
12.2%
13.0%
13.8%
4.5%
14.2%
4.2%
10.4%
11.5%
5.8%
3.5%
7.1%
2.9%
2.9%
12.7%
5.7%
3.3%
3.3%
6.0%
2.3%
5.0%
7.8%
12.5%
7.2%
31.3%
8.5%

 Service Area Map
Mercy General Hospital’s service area has approximately 1.5 million residents. There are ten
other hospitals located within Mercy General Hospital’s service area. There are four other
hospitals located within approximately 15 miles from Mercy General Hospital. Mercy General
Hospital has the fifth-largest inpatient market share leader in the service area.

98

 Hospital Market Share
The table below provides the market share of inpatient discharges by individual hospital within
Mercy General Hospital’s service area from CY 2013 to CY 2016.

MERCY GENERAL HOSPITAL
MARKET SHARE BY HOSPITAL CY 2013 - CY 2016
Hospital
CY 2013 CY 2014 CY 2015 CY 2016 Trend
Sutter Medical Center, Sacramento
6.8%
6.3%
10.2%
16.5%
↗
UC Davis Medical Center
13.7%
13.3%
12.6%
12.7%
↘
Mercy San Juan Medical Center
13.4%
14.0%
13.1%
11.2%
↘
Kaiser Foundation Hospital - South Sacramento
8.2%
8.6%
8.8%
9.3%
↗
Mercy General Hospital
10.1%
10.0%
9.2%
8.5%
↘
Kaiser Foundation Hospital - Roseville
7.1%
7.3%
8.1%
8.4%
↗
Methodist Hospital of Sacramento
7.4%
7.7%
8.1%
7.3%
↘
Kaiser Foundation Hospital - Sacramento
5.3%
5.1%
5.5%
6.1%
↗
Sutter Roseville Medical Center
3.9%
3.9%
3.6%
4.2%
↗
Mercy Hospital of Folsom
2.7%
2.9%
3.1%
3.1%
↗
Sierra Vista Hospital
2.4%
2.2%
2.4%
2.4%
→
Heritage Oaks Hospital
1.5%
1.7%
1.8%
1.8%
↗
Sutter Center For Psychiatry
1.1%
1.2%
1.2%
1.2%
→
Woodland Memorial Hospital
0.3%
0.5%
0.6%
0.7%
↗
Sutter Davis Hospital
0.6%
0.6%
0.6%
0.7%
→
UCSF Medical Center
0.4%
0.4%
0.4%
0.5%
→
St. Joseph's Behavioral Health Center
0.4%
0.6%
0.5%
0.3%
↘
Fremont Hospital
0.0%
0.0%
0.2%
0.3%
↗
Adventist Health Vallejo
0.1%
0.2%
0.3%
0.3%
↗
Crestwood Psychiatric Health Facility-Carmichael
0.5%
0.5%
0.3%
0.3%
↘
Sacramento Mental Health Treatment Center
0.7%
0.3%
0.2%
0.3%
↘
Crestwood Psychiatric Health Facility-Sacramento
0.4%
0.3%
0.3%
0.3%
→
Shriners Hospitals For Children Northern California
0.1%
0.2%
0.2%
0.2%
→
California Pacific Med Ctr-Pacific Campus
0.1%
0.1%
0.2%
0.1%
→
Stanford Health Care
0.2%
0.2%
0.2%
0.1%
→
All Other
12.4%
11.7%
8.5%
3.1%
↘
Total Percentage
100%
100%
100%
100%
Total Discharges
131,621 131,739 132,412 132,180
↗
Source: OSHPD Discharge Database, CY 2013 - CY 2016
Note: Excludes normal newborns

99



The number of discharges in Mercy General Hospital’s service area remained relatively
stable;



Sutter Medical Center, Sacramento is the market share leader based on inpatient
discharges (17% in CY 2016); and

 Market Share by Payer Type
The following table provides the service area’s hospital inpatient market share by payer type as
reported by OSHPD for CY 2016.

9.4%
5.8%
13.9%
1.4%
9.3%
12,134

Kaiser Foundation
Hospital - Sacramento

14.2%
13.4%
5.5%
7.1%
11.3%
14,742

Methodist Hospital Of
Sacramento

Kaiser Foundation
Hospital - South
Sacramento

11.7%
15.3%
11.5%
10.0%
12.8%
16,721

Kaiser Foundation
Hospital - Roseville

Mercy San Juan Medical
Center

13.5%
20.7%
14.5%
23.4%
16.4%
21,475

Mercy General Hospital

University Of California
Davis Medical Center

Total
Payer Type
Discharges
Medicare
47,633
Medi-Cal
42,188
Private Coverage
37,048
All Other
3,949
Total Percentage
Total Discharges
130,818
Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

Sutter Medical Center,
Sacramento

MERCY GENERAL HOSPITAL
HOSPITAL MARKET SHARE BY PAYER CY 2016

11.8%
7.8%
5.6%
3.5%
8.5%
11,147

6.0%
4.6%
16.7%
0.7%
8.4%
10,967

7.7%
10.4%
3.9%
3.3%
7.4%
9,643

9.6%
2.9%
5.8%
0.8%
6.1%
7,971

All
Others
16.0%
19.0%
22.7%
49.7%
19.9%
26,018

Total
100.0%
100.0%
100.0%
100.0%
100.0%



The largest payer types for inpatient discharges is Medicare with 47,633 inpatient (36%),
followed by Medi-Cal with 42,188 inpatient discharges (32%), and Private Coverage with
37,048 inpatient discharges (28%);



Mercy San Juan Medical Center is the market share leader for Medicare (14.2%);



Sutter Medical Center, Sacramento is the market share leader for Medi-Cal (20.7%); and



Kaiser Foundation Hospital Roseville is the market share leader for Private Coverage
(16.7%).

100

 Market Share by Service Line
The following table provides the service area’s inpatient market share by service line for CY
2016.

University Of California Davis
Medical Center

Mercy San Juan Medical Center

Kaiser Foundation Hospital - South
Sacramento

Mercy General Hospital

Kaiser Foundation Hospital –
Roseville

Methodist Hospital Of Sacramento

Kaiser Foundation Hospital –
Sacramento

Total
Service Line
Discharges
General Medicine
38,999
Obstetrics
20,026
Cardiac Services
12,606
Behavioral Health
11,913
General Surgery
11,455
Orthopedics
9,266
Neonatology
7,311
Neurology
5,377
Oncology/Hematology (Medical)
3,446
Other
2,174
Spine
2,105
Vascular Services
1,491
Urology
1,344
Gynecology
1,304
ENT
1,246
Neurosurgery
1,011
Rehabilitation
724
No-match-found
245
Total Percentage
Total Discharges
132,180
Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

Sutter Medical Center,
Sacramento

MERCY GENERAL HOSPITAL
HOSPITAL MARKET SHARE BY SERVICE LINE CY 2016

15.7%
32.1%
15.0%
1.3%
12.9%
12.6%
22.4%
16.0%
15.8%
7.9%
14.6%
21.3%
14.8%
16.1%
12.0%
13.3%
0.0%
15.5%
16.5%
21,807

15.6%
6.0%
12.8%
1.5%
16.5%
12.9%
8.2%
14.0%
26.1%
30.3%
16.9%
14.4%
16.7%
10.0%
30.6%
20.9%
3.7%
22.9%
12.7%
16,747

14.3%
7.4%
14.2%
2.1%
12.3%
10.8%
7.2%
15.6%
12.0%
19.2%
6.5%
19.6%
14.1%
14.8%
11.2%
15.2%
0.0%
13.9%
11.2%
14,841

8.6%
12.7%
9.3%
0.6%
11.7%
11.5%
17.2%
5.9%
5.5%
14.3%
3.4%
7.0%
13.3%
5.8%
15.6%
3.9%
0.0%
5.7%
9.3%
12,300

8.8%
5.0%
19.9%
0.8%
9.0%
9.4%
2.6%
8.3%
9.1%
3.4%
14.0%
13.2%
8.3%
15.0%
6.6%
5.3%
38.1%
6.1%
8.5%
11,192

6.2%
18.3%
6.0%
0.2%
5.7%
7.8%
25.5%
5.3%
7.8%
2.7%
1.8%
7.1%
4.5%
2.1%
5.6%
3.3%
0.0%
3.3%
8.4%
11,075

8.9%
8.6%
6.0%
0.7%
7.4%
8.2%
8.3%
8.8%
4.7%
2.4%
1.3%
3.6%
4.6%
13.5%
2.3%
0.2%
56.2%
2.4%
7.3%
9,706

8.7%
0.1%
6.5%
0.6%
8.7%
10.5%
0.0%
10.0%
6.3%
4.0%
19.8%
5.8%
4.6%
8.4%
4.7%
23.3%
0.0%
5.7%
6.1%
8,099

All
Others
13.2%
9.9%
10.3%
92.3%
15.8%
16.2%
8.7%
16.2%
12.6%
15.8%
21.8%
8.0%
19.0%
14.4%
11.4%
14.6%
1.9%
24.5%
20.0%
26,413

Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%



Mercy General Hospital is the service line leader for cardiac services (20%);



Sutter Medical Center, Sacramento is the service area service line leader in five of 18
service lines: general medicine (16%), obstetrics (32%), neurology (16%); vascular
services (21%), and gynecology (16%); and



University of California, Davis Medical Center is the service line leader in seven of 18
service lines including: general surgery (17%), orthopedics (13%), oncology/hematology
(26%), and urology (17%).

101

 Market Share by ZIP Code
The following table provides the service area’s hospital market share by ZIP Code for CY 2016.

102

Kaiser Foundation
Hospital - South
Sacramento

Mercy General
Hospital

Kaiser Foundation
Hospital - Roseville

Methodist Hospital
Of Sacramento

Kaiser Foundation
Hospital –
Sacramento

132,180

Note: Excludes normal newborns
Source: CY 2016 OSHPD Patient Discharge Database

Mercy San Juan
Hospital

Total
Discharges
8,524
6,429
5,823
5,180
4,744
4,638
4,558
4,455
4,321
4,273
4,267
4,169
4,120
3,881
3,751
3,519
3,433
3,349
3,340
3,296
3,286
3,214
3,195
2,951
2,742
2,456
2,381
2,370
2,093
2,001
1,821
1,819
1,717
1,705
1,604
1,446
1,355
1,261
1,205
959
280
116
69
48
16

University Of
California Davis
Medical Center

ZIP Code
Community
95823
Sacramento
95608
Carmichael
95828
Sacramento
95670
Rancho Cordova
95822
Sacramento
95624
Elk Grove
95630
Folsom
95621
Citrus Heights
95758
Elk Grove
95610
Citrus Heights
95820
Sacramento
95660
North Highlands
95838
Sacramento
95821
Sacramento
95628
Fair Oaks
95825
Sacramento
95815
Sacramento
95831
Sacramento
95824
Sacramento
95833
Sacramento
95842
Sacramento
95691
West Sacramento
95826
Sacramento
95662
Orangevale
95757
Elk Grove
95835
Sacramento
95841
Sacramento
95834
Sacramento
95827
Sacramento
95829
Sacramento
95864
Sacramento
95673
Rio Linda
95818
Sacramento
95817
Sacramento
95816
Sacramento
95605
West Sacramento
95814
Sacramento
95819
Sacramento
95832
Sacramento
95811
Sacramento
95655
Mather
95612
Clarksburg
95652
Mcclellan
95865
Sacramento
95853
Sacramento
Total Percentage
Total Discharges

Sutter Medical
Center, Sacramento

MERCY GENERAL HOSPITAL
HOSPITAL MARKET SHARE BY ZIP CODE CY 2016

14.8%
11.0%
14.4%
12.6%
20.0%
16.6%
4.3%
5.5%
18.1%
5.9%
16.8%
10.0%
23.4%
18.9%
5.9%
25.7%
27.0%
25.9%
19.0%
25.2%
9.7%
24.0%
18.9%
4.4%
18.5%
23.2%
8.5%
23.7%
16.0%
14.9%
23.0%
12.6%
27.8%
18.1%
32.3%
25.4%
26.6%
27.6%
17.7%
30.9%
12.1%
26.7%
15.9%
20.8%
31.3%
16.5%
21,807

11.3%
8.0%
11.7%
16.4%
15.2%
10.3%
7.6%
4.9%
10.0%
6.1%
29.7%
8.1%
13.0%
10.5%
7.5%
10.7%
12.3%
14.8%
23.0%
15.3%
7.2%
18.6%
17.2%
5.7%
10.1%
14.8%
7.3%
12.4%
18.8%
12.2%
11.0%
8.3%
18.9%
33.7%
14.0%
19.9%
20.7%
15.4%
15.2%
12.2%
13.6%
6.9%
7.2%
4.2%
12.5%
12.7%
16,747

2.5%
35.2%
2.6%
13.8%
2.2%
1.9%
6.8%
29.1%
1.9%
27.1%
2.0%
35.7%
11.5%
17.3%
28.5%
5.7%
6.8%
1.6%
2.2%
3.9%
32.1%
1.9%
4.1%
16.8%
1.6%
5.3%
37.5%
3.5%
6.4%
2.7%
8.3%
25.1%
2.1%
2.1%
2.7%
2.1%
3.2%
1.9%
1.9%
3.1%
6.8%
1.7%
17.4%
0.0%
12.5%
11.2%
14,841

22.1%
1.2%
24.1%
2.3%
19.8%
29.5%
0.9%
1.1%
28.1%
0.9%
12.1%
1.0%
2.0%
2.1%
1.4%
2.3%
2.0%
21.4%
13.7%
4.0%
1.0%
6.1%
4.1%
0.8%
29.6%
3.6%
1.3%
4.2%
3.2%
27.6%
2.0%
2.0%
9.7%
8.3%
3.9%
3.0%
3.5%
4.4%
20.4%
2.1%
5.7%
22.4%
2.9%
0.0%
12.5%
9.3%
12,300

7.4%
4.4%
7.6%
5.9%
11.6%
6.2%
4.5%
2.9%
7.3%
2.9%
11.3%
4.2%
14.1%
9.3%
3.5%
15.2%
14.7%
11.2%
10.9%
11.3%
3.3%
10.5%
13.2%
3.3%
5.8%
12.5%
2.3%
12.0%
12.2%
5.7%
15.6%
7.1%
13.0%
10.4%
13.8%
11.5%
14.2%
21.3%
6.0%
12.7%
5.0%
7.8%
7.2%
12.5%
31.3%
8.5%
11,192

2.0%
9.7%
2.3%
10.4%
2.3%
2.8%
19.4%
22.0%
3.1%
20.4%
3.0%
10.8%
8.2%
7.3%
18.6%
5.2%
5.0%
3.3%
1.3%
9.7%
16.3%
6.4%
8.3%
23.9%
3.0%
14.6%
10.9%
11.6%
7.9%
3.7%
6.9%
13.7%
4.5%
2.8%
3.1%
3.8%
1.9%
7.1%
2.6%
3.4%
19.6%
1.7%
4.3%
2.1%
0.0%
8.4%
11,075

23.8%
1.3%
22.0%
2.5%
15.2%
19.8%
0.9%
1.0%
17.9%
0.8%
6.4%
1.3%
3.0%
3.1%
1.0%
3.4%
2.7%
8.5%
16.8%
3.2%
1.8%
2.1%
3.8%
0.7%
17.7%
2.1%
1.4%
3.2%
2.6%
17.0%
1.3%
1.8%
2.5%
3.7%
2.2%
1.9%
1.4%
1.1%
21.8%
2.7%
3.2%
12.1%
2.9%
4.2%
0.0%
7.3%
9,706

1.4%
11.8%
2.1%
9.2%
1.7%
2.1%
2.3%
2.6%
1.9%
2.3%
2.5%
7.3%
10.3%
16.3%
4.2%
18.0%
11.6%
1.8%
1.1%
11.7%
4.2%
7.0%
14.8%
2.6%
1.5%
9.1%
5.5%
8.1%
12.0%
1.7%
16.5%
11.3%
6.1%
2.4%
6.0%
6.0%
4.0%
9.8%
1.7%
4.1%
11.1%
0.0%
11.6%
4.2%
0.0%
6.1%
8,099

All
Others
14.7%
17.5%
13.1%
26.9%
12.0%
10.8%
53.3%
30.8%
11.8%
33.7%
16.1%
21.6%
14.4%
15.3%
29.5%
13.8%
18.0%
11.6%
12.0%
15.6%
24.3%
23.4%
15.5%
41.7%
12.3%
14.8%
25.3%
21.2%
21.0%
14.3%
15.4%
18.0%
15.4%
18.6%
22.0%
26.3%
24.4%
11.3%
12.7%
28.8%
22.9%
20.7%
30.4%
52.1%
0.0%
20.0%
26,413

Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%

 

Mercy General Hospital is the inpatient market share leader in one of the 45 ZIP Codes
in Sacramento;



Sutter Medical Center, Sacramento is the market share leader in 21 of the 45 ZIP Codes;
and



Mercy San Juan Medical Center is also a market share leader in nine of the 45 ZIP Codes.

103

 Assessment of Potential Issues Associated with the Availability or Accessibility
of Healthcare Services
In the Ministry Alignment Agreement, Dignity Health and CHI have made commitments to
maintain all Dignity Health owned hospitals, IHO owned hospitals, and IHO subsidiary hospitals
with their current levels of health services and programs. An analysis of these commitments is
provided in the following sections.
Continuation as General Acute Care Hospitals
In the Ministry Alignment Agreement, Dignity Health and CHI committed to maintaining
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom
and Mercy General Hospital as licensed acute care hospitals for five years after the Effective
Date. Each hospital provides a significant amount of healthcare to the communities served as
shown by their inpatient volume and market share.
Methodist Hospital of Sacramento
In FY 2017, the hospitals located within Methodist Hospital of Sacramento’s service area had a
combined total of 1,415 licensed beds with an aggregate average occupancy rate of
approximately 76%. In FY 2017, the Hospital had 329 licensed beds that operated at an
occupancy rate of 79%. In CY 2016, it had a 16% market share of the service area inpatient
discharges. Furthermore, of the hospitals located within Methodist Hospital of Sacramento’s
service area, the Hospital had 17% of the total inpatient discharges, representing 24% of the
patient days. The table below shows the hospitals located within the Hospital’s service area.
SERVICE AREA HOSPITAL DATA
Hospital
City
Methodist Hospital Of Sacramento
Sacramento
1
Kaiser Foundation Hospitals - South Sacramento
Sacramento
University Of California, Davis Med Center
Sacramento
1
Sierra Vista Hospital
Sacramento
Sutter Center For Psychiatry
Sacramento
Total
Source: OSHPD Disclosure Report, Google Maps
1
FY2017 OSHPD Discharges not reported. Audited FY 2016 is shown

Licensed
Beds
329
217
625
171
73
1,415

Inpatient
Discharges
10,582
14,412
30,850
4,919
2,886
63,649

Patient
Days
95,239
47,056
186,185
44,650
20,245
393,375

Average
Daily Census
261
129
510
122
55
1,078

Percent
Occupied
79%
59%
82%
72%
76%
76%

Miles From Hospital
0.7
9.5
0.2
7.4

Since Methodist Hospital of Sacramento has the second-highest occupancy rate (79%) and has
about 16% market share of the hospitals located within the service area, it is a very important
provider of healthcare services to the community.

104

 Mercy San Juan Medical Center
In FY 2017, the hospitals located within Mercy San Juan Medical Center’s service area had a
combined total of 1,520 licensed beds with an aggregate average occupancy rate of 66%. In FY
2017, Mercy San Juan Medical Center had 370 licensed beds that operated at an occupancy
rate of 71%. In CY 2016, Mercy San Juan Medical Center was the market share leader with
18.0% of the service area discharges. Furthermore, of the hospitals located within Mercy San
Juan Medical Center’s service area, Mercy San Juan Medical Center had 26% of both the total
inpatient discharges and patient days. The following table shows the hospitals located with
Mercy San Juan Medical Center’s service area.

SERVICE AREA HOSPITAL DATA
Hospital
City
Mercy San Juan Medical Center
Carmichael
Kaiser Foundation Hospitals - Roseville
Roseville
Sutter Roseville Medical Center
Roseville
Kaiser Foundation Hospitals – Sacramento
Sacramento
Heritage Oaks Hospital
Sacramento
Sutter Center For Psychiatry
Sacramento
Total
Source: OSHPD Disclosure Report, Google Maps

Licensed
Beds
370
340
325
287
125
73
1,520

Inpatient
Discharges
20,298
20,557
20,180
11,000
3,870
2,923
78,828

Patient
Days
95,314
73,933
90,605
44,376
39,667
20,692
364,587

Average Percent
Daily Census Occupied
261
71%
203
60%
248
76%
122
42%
109
87%
57
78%
999
66%

Miles From Hospital
7.4
8.7
7.7
3.8
12.2

Since Mercy San Juan Medical Center has the most licensed beds, has a high occupancy rate
(71%), and is the market share leader of inpatient discharges of the hospitals located within the
service area, it is a very important provider of healthcare services to the community.
Mercy Hospital of Folsom
In FY 2017, the hospitals located within Mercy Hospital of Folsom's service area had a combined
total of 659 licensed beds with an aggregate average occupancy rate of 67%. In FY 2017 Mercy
Hospital of Folsom had 106 licensed beds that operated at an occupancy rate of 61%. In CY
2016, Mercy Hospital of Folsom was the third-largest market share leader with 13% of the
service area inpatient discharges. Furthermore, of the hospitals located within Mercy Hospital
of Folsom’s service area, Mercy Hospital of Folsom had 21% of the total inpatient discharges,
representing 15% of the patient days. The following table shows the hospitals located within
Mercy Hospital of Folsom’s service area.

Licensed
Beds
106
370
58
125
659

SERVICE AREA HOSPITAL DATA
Inpatient
Patient
Discharges
Days
6,880
23,633
20,298
95,314
677
17,313
5,528
24,722
33,383
160,982

Hospital
City
Mercy Hospital Of Folsom
Folsom
Mercy San Juan Medical Center
Carmichael
Vibra Hospital Of Sacramento1
Folsom
Marshall Hospital
Placerville
Total
Source: OSHPD Disclosure Report
1 FY2017 OSHPD Discharges not reported. Only "submitted" FY 2016 is available.

105

Average Daily
Census
65
261
47
68
441

Percent
Occupied
61.1%
70.6%
81.8%
54.2%
67%

Miles From
Hospital
10.6
1.7
22.9

 While Mercy Hospital of Folsom does not have the most inpatient discharges, given its
occupancy rate (61%), it is a very important provider of healthcare services to the community.
Mercy General
In FY 2017, the hospitals located within Mercy General Hospital’s service area had a combined
total of 3,141 licensed beds with an aggregate average occupancy rate of 68%. In FY 2017,
Sutter Medical Center - Sacramento was the largest hospital within the service area, with 523
licensed beds that operated at an occupancy rate of 70%. Mercy General Hospital was the
second-largest area hospital with 419 licensed beds, operating at a 43% occupancy rate. In CY
2016, Sutter Medical Center, Sacramento was the market share leader with 16.6% of the
service area inpatient discharges. Furthermore, Mercy General Hospital had 11% of the total
inpatient discharges, representing 9% of the patient days. The table below shows the hospitals
located within Mercy General Hospital’s service area.

Hospital
Mercy General Hospital
Sutter Medical Center - Sacramento
Mercy San Juan Medical Center
Kaiser Foundation Hospitals - Sacramento
Heritage Oaks Hospital
Sutter Center For Psychiatry
Sierra Vista Hospital
Methodist Hospital Of Sacramento
Kaiser Foundation Hospitals - South Sacramento
University Of California Davis Medical Center
Total

SERVICE AREA HOSPITAL DATA
Licensed
Inpatient
City
Beds
Discharges
Sacramento
419
15,535
Sacramento
523
30,763
Carmichael
370
21,097
Sacramento
287
11,000
Sacramento
125
3,870
Sacramento
73
2,923
Sacramento
171
4,919
Sacramento
329
11,072
Sacramento
217
14,412
Sacramento
627
31,312
3,141
146,903

Patient
Days
66,071
134,400
103,767
44,376
39,667
20,692
44,650
95,209
47,056
178,210
774,098

Average
Daily Census
181
368
284
122
109
57
122
261
129
488
2,121

Percent
Occupied
43%
70%
77%
42%
87%
78%
72%
79%
59%
78%
68%

Miles From
Hospital
1.2
13.1
5.9
8.9
3.1
8.7
8.9
8.8
1.5

Source: OSHPD Disclosure Report, Google Maps

Since Mercy General Hospital ranks in the top five in licensed beds, inpatient discharges,
patient days, and average daily census among the hospitals located within its service area, it is
an important provider of healthcare services to the community.
Emergency Services
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom,
and Mercy General Hospital are important providers of emergency services to the residents of
their respective surrounding communities. In FY 2017, Methodist Hospital of Sacramento
reported 66,123 emergency service visits to its 29 emergency treatment stations, operating at
over 114% capacity30. During that same time period, Mercy San Juan Medical Center (a Level II
Trauma Center) reported 74,867 emergency service visits to its 31 treatment stations,
operating at 121% of capacity. In FY 2017, Mercy Hospital of Folsom reported 48,421
emergency service visits to its 25 emergency treatment stations, operating at 97% capacity. In

30

Industry sources, including the American College of Emergency Physicians, use a benchmark of 2,000 visits per emergency station, per year,
to estimate the capacity.

106

 FY 2017, Mercy General Hospital reported 45,026 emergency service visits to its 20 emergency
treatment stations, operating at over 113% capacity.
As a result of the ACA and California’s participation in Medicaid expansion, more individuals are
now eligible for healthcare coverage. This influx of newly insured individuals, combined with
the growing shortage of primary care physicians, is expected to increase emergency
department utilization. Keeping Methodist Hospital of Sacramento’s, Mercy San Juan Medical
Center’s, Mercy Hospital of Folsom’s, and Mercy General Hospital’s emergency departments
open is important for providing area residents access to emergency services.
In the Ministry Alignment Agreement, Dignity Health and CHI committed to maintaining the
emergency services at all Dignity Health owned hospitals, IHO owned hospitals, and IHO
subsidiary hospitals at current types and levels of services and current designations for five
years after the Effective Date of the Ministry Alignment Agreement as shown below:
The five-year commitments to Methodist Hospital of Sacramento’s existing emergency services
include:
● 29 Treatment Stations; and
● Certified Primary Stroke Center.
The five-year commitments to Mercy San Juan Medical Center’s existing emergency services
include:
●
●
●
●

31 Treatment Stations;
Paramedic Base Station;
Level II Trauma Center; and
Certified Comprehensive Stroke Center.

The five-year commitments to Mercy Hospital of Folsom’s existing emergency services include:
● 25 Treatment Stations.
The five-year Commitments to Mercy General Hospital’s existing emergency services include:
● 20 Treatment Stations;
● STEMI Receiving Center; and
● Certified Primary Stroke Center.
As a result of healthcare reform, aging demographics, and the growing shortage of primary care
physicians, emergency department utilization is expected to continue to increase within each
hospital’s service area. Maintaining Methodist Hospital of Sacramento’s, Mercy San Juan
Medical Center’s, Mercy Hospital of Folsom’s and Mercy General Hospital’s emergency
departments open with at least their current number of emergency department stations and
107

 current Trauma Center Level designations is critical to providing emergency services within
each Hospital’s service area.
Reproductive Health Services
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom,
and Mercy General Hospital are all important providers of healthcare services to women. These
four hospitals reported the following average live births per year between FY 2015 and FY 2017:





Methodist Hospital of Sacramento: 1,836 live births per year;
Mercy San Juan Medical Center: 1,980 live births per year;
Mercy Hospital of Folsom: 880 live births per year; and
Mercy General Hospital: 1,279 live births per year.

Methodist Hospital of Sacramento is a non-Catholic hospital and is not subject to the ERDs.
Under the Ministry Alignment Agreement, all Dignity Health non-Catholic hospitals are not
subject to the ERDs. Dignity Health’s non-Catholic hospitals will transition to IHO on the
Effective Date. All IHO hospitals will adopt Dignity Health’s Statement of Common Values that
prohibits direct abortion, in-vitro fertilization, and physician-assisted suicide. Because these
hospitals are subject to Dignity Health’s Statement of Common Values and not to the ERDs, no
reductions in the availability or accessibility of reproductive healthcare services are expected at
Methodist Hospital of Sacramento as a result of this transaction.
Mercy San Juan Medical Center, Mercy Hospital of Folsom, and Mercy General Hospital are
Catholic hospitals and currently subject to the ERDs and will continue to be subject to the ERDs
after the Effective Date.
Under the ERDs, some women’s reproductive health services, including direct abortions and
tubal ligations, are prohibited. Although the ERDs prohibit tubal ligations and direct abortions,
these procedures are performed at Mercy San Juan Medical Center, Mercy Hospital of Folsom,
and Mercy General Hospital when the pathology is determined to present a medical need
and/or a clear and present danger to the patient. Mercy San Juan Medical Center, Mercy
Hospital of Folsom, and Mercy General Hospital are important providers of a range of women’s
reproductive services and provided these services to a large underserved population that has
lower rates of prenatal care, resulting in an increased number of high-risk births. This can
increase instances of stillborn delivery, miscarriage, and fetal abnormalities.
No future reductions in availability and accessibility of reproductive health services are
expected at Mercy San Juan Medical Center, Mercy Hospital of Folsom, or Mercy General
Hospital as a result of the Ministry Alignment Agreement.
The following table shows recorded inpatient reproductive service procedures in CY 2016 at
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom
and Mercy General Hospital.
108

 CY 2016 REPRODUCTIVE SERVICE BY DIAGNOSTIC RELATED GROUP

Diagnostic Related Group
767-Vaginal Delivery W Sterilization &/Or D&C1
770-Abortion W D&C1, Aspiration Curettage Or Hysteroctomy
779-Abortion W/O D&C1
777-Ectopic Pregnancy
778-Threatened Abortion
Total Discharges:

Methodist
Hospital of
Sacramento
41
3
1
12
14
71

Mercy San
Juan
Medical
Center
23
4
1
5
31
64

Mercy
Hospital of
Folsom
8
1
1
2
6
18

Mercy
General
Hospital
5
2
5
10
5
27

Source: CY 2016 OSHPD Patient Discharge Database
1
D&C is an abbreviation for Dilation and Curettage

Effects on the Level & Type of Charity Care Historically Provided
Dignity Health committed to providing an annual amount of charity care based on the three
most recent fiscal years as shown in the following table. As noted previously, Dignity Health has
acknowledged that an error was made in its calculation of charity care costs. Dignity Health has
stated that they will comply with the charity care cost amounts determined in the manner
previously described.
CHARITY CARE COSTS
Dignity Health1
FY 2015FY 2013FY 2017
FY 2017
Average
Average
Methodist Hospital of Sacramento
$2,635,248
$3,575,851
Mercy San Juan Medical Center
$3,834,410
$4,104,187
Mercy Hospital of Folsom
$940,489
$960,532
Mercy General Hospital
$2,286,344
$2,889,469
1 Dignity Health charity care commitment as calculated by Dignity Health FY 2015 - FY 2017
2 Charity care as reported in OSHPD Disclosure Reports FY 2013 - FY 2017.

OSHPD Reported2
FY 2015FY 2017
Average
$3,575,851
$4,357,297
$936,615
$3,509,732

FY 2013FY 2017
Average
$3,768,607
$5,505,792
$1,001,837
$3,073,105

Effects on Services to Medi-Cal, Medicare & Other Classes of Patients
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom,
and Mercy General Hospital all participate in the Medicare and Medi-Cal programs, contract
with Medi-Cal managed care plans, and provide services to other indigent, county indigent, and
private pay patients.
As a result of the expansion of Medi-Cal and the ACA, fewer low-income individuals and families
are uninsured. Additionally, in Sacramento County, qualified low-income patients are able to
access the County owned clinics and hospitals. As a result, county indigent and other indigent
patients have decreased. While these patients can still access the emergency departments of
Dignity Health Hospitals, the number of patients served has deceased.

109

 Commercially insured patients receive care at Dignity Health hospitals under negotiated
contracts and are unlikely to be affected as result of the Dignity Health and CHI transaction.
The Medi-Cal Managed Care Program contracts for healthcare services through established
networks of organized systems of care. Over 12 million Medi-Cal beneficiaries in all 58 counties
in California receive their healthcare through six models of managed care, including: County
Organized Health Systems, the Two-Plan Model, Geographic Managed Care, the Regional
Model, the Imperial Model, and the San Benito Model.
Sacramento County has a Geographic Managed Care Model that offers several commercial
plans.
The percentage of Sacramento County residents with Medi-Cal Managed Care coverage has
increased significantly as a result of the ACA and California initiatives to expand managed care.
In Sacramento County, the Geographic Managed Care Model is provided by: Aetna Better
Health, Anthem Blue Cross, Health Net, Kaiser Health Plan, Molina Healthcare, and
UnitedHealthcare Community Plan31.Currently, Dignity Health is contracted with Anthem Blue
Cross, Health Net, and Molina Health Plan.
In the Ministry Alignment Agreement Dignity Health and CHI commit to continued participation
in the Medi-Cal and Medicare program for a period of five years after the Effective Date. The
table shows current contracts that exist at Dignity Health’s Sacramento County Hospitals.

31

This plan will exit the Sacramento County Geographic Managed Care on October 31, 2018.

110

 DIGNITY HEALTH
SACRAMENTO COUNTY MEDI-CAL CONTRACTS
Dignity Health Hospital
Health Plan
Methodist Hospital of Sacramento
 Anthem Blue Cross Medi-Cal (Sacramento)

Mercy San Juan Medical Center

Mercy Hospital of Folsom

Mercy General Hospital













Health Net
Molina Health Plan (Sacramento)
Anthem Blue Cross Medi-Cal (Sacramento)
Health Net
Molina Health Plan (Sacramento)
Anthem Blue Cross Medi-Cal (Sacramento)
Health Net
Molina Health Plan (Sacramento)
Anthem Blue Cross Medi-Cal (Sacramento)
Health Net
Molina Health Plan (Sacramento)

Source: Dignity Health

As Dignity Health committed to continued participation in the Medicare, Medi-Cal, and MediCal managed care programs in the Ministry Alignment Agreement, no reductions in the
availability or accessibility of non-emergency healthcare services are anticipated for
beneficiaries of Medicare, Medi-Cal, and Medi-Cal managed care programs for at least five
years after the Effective Date.
Effects on Community Benefit Programs
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom,
and Mercy General Hospital support a significant number of ongoing community benefit
programs that serve the residents of the surrounding communities. In the Ministry Alignment
Agreement, Dignity Health and CHI have made commitments to maintain expenditures for
community benefit services based on an average of the expenditures for the years FY 20152017. The table below shows the annual average for both the three and five fiscal years at
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom,
and Mercy General Hospital.
SACRAMENTO COUNTY COMMUNITY BENEFIT
FY 2015 - FY 2017*
$4,840,883
Methodist Hospital of Sacramento
$5,688,941
Mercy San Juan Medical Center
$1,318,780
Mercy Hospital of Folsom
$6,662,519
Mercy General Hospital

FY 2013 – FY 2017*
$4,466,439
$5,288,729
$1,709,910
$7,164,131

*Less Medi-Cal Provider Fees and other non-community benefit costs as detailed in the profile sections.

While all four facilities offer various community benefit programs, the Ministry Alignment
Agreement includes commitments to maintain many of the current community benefit
programs. The table below shows the service and program commitments made by Dignity
Health and CHI.
111

 COMMITTED COMMUNITY BENEFIT SERVICES AND PROGRAMS
Hospital Name

Community Benefit Service and Program Name

Methodist Hospital of Sacramento


















Mercy San Juan Medical Center

Mercy Hospital of Folsom

Mercy General Hospital

Chronic Disease Self-Management Program
Lutheran Social Services Homeless Housing
Wellspace Interim Care Program
Mercy Family Health Center (Family Practice Residency)
Dignity Health Community Grants
Chronic Disease Self-Management Program
Lutheran Social Services Homeless Housing
Wellspace Interim Care Program)
Dignity Health Community Grants
Chronic Disease Self-Management Program
Lutheran Social Services Homeless Housing
Dignity Health Community Grants
Chronic Disease Self-Management Program
Lutheran Social Services Homeless Housing
Wellspace Interim Care Program
Dignity Health Community Grants

Effects on Hospital Licensed Services
Methodist Hospital of Sacramento, Mercy San Juan Medical Center Mercy Hospital of Folsom,
and Mercy General Hospital are important providers of inpatient services to the residents of
their respective communities. Dignity Health and CHI committed to maintaining all licensed
services at current types and levels of services and current designations for five years after the
Effective Date of the Ministry Alignment Agreement as follows:
Licensed Service Commitments for Methodist Hospital of Sacramento:
● Obstetric services, including a minimum of 22 licensed perinatal beds;
● Intensive Care Newborn Nursery services, including a minimum of 12 licensed neonatal
intensive care unit beds;
● Critical care services, including a minimum of 10 licensed intensive care beds and a
minimum of 10 licensed coronary care beds; and
● Skilled nursing services, including a minimum of 171 distinct part skilled nursing beds
(Bruceville Terrace).
Licensed Service Commitments for Mercy San Juan Medical Center:
● Critical care services, including a minimum of 45 licensed intensive care beds and a
minimum of 11 licensed coronary care beds; and
● Obstetric services, including a minimum of 32 licensed perinatal beds;
● Intensive Care Newborn Nursery services, including a minimum of 26 licensed neonatal
intensive care unit beds; and
● Pediatric services, including a minimum of 8 licensed pediatric beds.

112

 Licensed Service Commitments for Mercy Hospital of Folsom:
● Obstetrics care, including a minimum of 8 licensed perinatal beds; and
● Intensive care services, including a minimum of 8 licensed intensive care beds.
Licensed Service Commitments for Mercy General Hospital:
● Intensive care services, including a minimum of 46 licensed intensive care beds;
● Rehabilitation services, including a minimum of 30 licensed rehabilitation beds; and
● Obstetric services, including a minimum of 17 licensed perinatal beds.
Since Dignity Health and CHI make extensive five-year commitments to licensed inpatient
services, no reductions in the availability or accessibility of healthcare services are expected for
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom
and Mercy General Hospital for at least five years as a result of the Ministry Alignment
Agreement.
Effects on Programs and Services
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom,
and Mercy General Hospital are important providers of inpatient and outpatient programs and
services to the residents of their respective surrounding communities. Dignity Health and CHI
committed to maintaining additional licensed programs and services at current types and levels
and current designations for five years after the Effective Date of the Ministry Alignment
Agreement as follows:
Programs and Services Commitment for Methodist Hospital of Sacramento:
●
●
●
●
●
●
●
●
●
●
●
●
●
●

113

General cardiology services;
Oncology services, including inpatient medical and surgical oncology services;
Orthopedic surgery services, including total joint replacements;
General surgery services, including bariatric surgery services;
Outpatient Clinic – Mercy Family Health Center Clinic;
Outpatient Services - Surgery at Dignity Health Medical Plaza;
Nuclear medicine services;
Imaging and radiology services (inpatient and outpatient);
Laboratory services;
Occupational therapy services;
Physical therapy services;
Respiratory care services;
Social services; and
Speech pathology services.

 Programs and Services Commitment for Mercy San Juan Medical Center:
●
●
●
●
●
●
●
●
●
●
●
●
●
●

Cardiovascular services and cardiac catheterization laboratory services;
Cardiovascular surgery services;
Interventional cardiology services;
Electrophysiology services, and general cardiology services;
Oncology services, including radiation therapy and outpatient chemotherapy;
Orthopedic surgery services, including total joint replacements;
General surgery services, including bariatric surgery services;
Outpatient Services – Surgery;
Outpatient Services – ED Fast Track Clinic32;
Nuclear medicine services;
Imaging and radiology services (inpatient and outpatient);
Laboratory services;
Physical therapy services; and
Respiratory care services.

Programs and Services Commitment for Mercy Hospital of Folsom:
●
●
●
●
●
●
●
●
●
●

32

Cardiovascular services, including general cardiology;
Neuroscience services, including general neuroscience services;
Orthopedic surgery services, including total joint replacements;
General surgery services;
Outpatient Services - Rehabilitation Services;
Nuclear medicine services;
Imaging and radiology services (inpatient and outpatient);
Laboratory services;
Physical therapy services; and
Respiratory care services.

While Dignity Health committed Methodist Hospital of Sacramento to ED Fast Track Clinic, this is no longer in service and has been replaced
with a crisis stabilization unit.

114

 Programs and Services Commitment Mercy General Hospital:
● Oncology services, including inpatient medical and surgical oncology services;
o Radiation therapy services;
o Outpatient Services – chemotherapy;
● Neuroscience services, including neurosurgery services;
● Outpatient Services – Neurology/Cath Lab;
● Orthopedic surgery services, including total joint replacements;
● General surgery services;
● Outpatient Services - Women’s Health Clinic;
● Nuclear medicine services;
● Imaging and radiology services (inpatient and outpatient), including Mobile Unit – MRI;
● Outpatient Services – clinical pathology/cardiology;
● Laboratory services;
● Occupational therapy services;
● Physical therapy services;
● Respiratory care services;
● Social services;
● Speech pathology services; and
● Speech therapy services.
Since Dignity Health and CHI have committed to maintaining these additional licensed services
and programs for five years after the Effective Date at Methodist Hospital of Sacramento,
Mercy San Juan Medical Center, Mercy Hospital of Folsom, and Mercy General Hospital, no
negative impacts on the access and availability of healthcare services are expected for at least
five years as a result of the Ministry Alignment Agreement.
Effects on Staffing & Employee Rights
Dignity Health states that the proposed transaction will not change the status of any of Dignity
Health’s non-executive employees.
Dignity Health and CHI in the Ministry Alignment Agreement also agree to maintain the
respective terms of the collective bargaining agreements that are in effect as of the Effective
Date as shown below.
Union Contracts for Methodist Hospital of Sacramento:





115

California Nurses Association (CNA);
Engineers L39 (ENGR L39);
Engineers and Scientists of California Local 20, (ESC); and
Service Employees International Union- United Healthcare Workers West (SEIU UHW).

 Union Contracts for Mercy San Juan Medical Center:




California Nurses Association (CNA);
Engineers and Scientists of California Local 20, (ESC); and
Service Employees International Union- United Healthcare Workers West (SEIU UHW).

Union Contracts for Mercy Hospital of Folsom:




California Nurses Association (CNA);
Engineers and Scientists of California Local 20, (ESC); and
Service Employees International Union- United Healthcare Workers West (SEIU UHW).

Union Contracts for Mercy General Hospital:




California Nurses Association (CNA);
Engineers and Scientists of California Local 20, (ESC); and
Service Employees International Union- United Healthcare Workers West (SEIU UHW).

It is anticipated that no reductions in the number of non-executive employees are expected at
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom,
and Mercy General Hospital as a result of the Ministry Alignment Agreement.
Effects on Medical Staff
Dignity Health and CHI have committed to maintaining privileges for the current medical staff
members of each Dignity Health California Hospital who are in good standing as of the Effective
Date of the Ministry Alignment Agreement. Since Dignity Health committed to maintain the
medical staffs’ privileges, no reductions in the medical staff at Methodist Hospital of
Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom, and Mercy General
Hospital are expected.
Effects on City and County Contracts
Methodist Hospital of Sacramento, Mercy San Juan Medical Center, Mercy Hospital of Folsom,
and Mercy General Hospital have a number of contracts with Sacramento County to provide
and support specific services. According to the Ministry Alignment Agreement, these contracts
will be maintained for a period of five years after the Effective Date, unless the contract is
terminated for cause or expires in accordance with its current terms.
Alternatives
If the proposed Ministry Alignment Agreement is not approved, Dignity Health is expected to
continue to operate as it has in the past. It may look for future partnerships; however, none are
evident at this time.
116

 Conclusions and Recommendations
Based on Dignity Health’s and CHI’s commitments contained in the Ministry Alignment
Agreement, the proposed transaction is likely to preserve the accessibility and availability of
healthcare services to the communities served for at least five years. If the transaction is not
approved, Dignity Health will have no obligation to maintain these commitments.
Potential Conditions for California Attorney General Approval of the Ministry Alignment
Agreement
If the California Attorney General approves the proposed transaction, JD Healthcare Inc. and
Vizient Inc. recommend the following conditions be required to minimize any potential negative
healthcare impact that might result from the transaction:
Methodist Hospital of Sacramento
1. For at least ten years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall continue to operate as a general acute care
hospital;
2. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall maintain 24-hour emergency services at no less
than current licensure and designation with the same types and/or levels of services,
including the following:
a. 29 Treatment Stations; and
b. Certified Primary Stroke Center.
3. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall maintain the following services at current
licensure, types, and/or levels of services:
a. Obstetric services, including a minimum of 22 licensed perinatal beds;
b. Intensive Care Newborn Nursery services, including a minimum of 12 licensed
neonatal intensive care unit beds;
c. Critical care services, including a minimum of 10 licensed intensive care beds and
a minimum of 10 licensed coronary care beds; and
d. Skilled nursing services, including a minimum of 171 distinct part skilled nursing
beds (Bruceville Terrace).
4. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall maintain the following services as committed to
Attachment D in Exhibit L of the Ministry Alignment Agreement:

117

 a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.

General cardiology services;
Oncology services, including inpatient medical and surgical oncology services;
Orthopedic surgery services, including total joint replacements;
General surgery services, including bariatric surgery services;
Outpatient Clinic – Mercy Family Health Center Clinic;
Outpatient Services - Surgery at Dignity Health Medical Plaza ;
Nuclear medicine services;
Imaging and radiology services (inpatient and outpatient);
Laboratory services;
Occupational therapy services;
Physical therapy services;
Respiratory care services;
Social services; and
Speech pathology services.

5. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall maintain currently provided women’s
healthcare services.
6. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall maintain a charity care policy that is no less
favorable than its current charity care policy and in compliance with California and
Federal law, and Methodist Hospital of Sacramento shall provide an annual amount of
charity care equal to or greater than $3,768,607 (the “Minimum Charity Care Amount”).
Alternatively, because of the impact of Medi-Cal expansion and the ACA, the California
Attorney General could consider adjusting the required commitment to charity care
based on available data from time periods after implementation of the ACA. An example
would be to require a commitment based on a three-year rolling average of the most
recent available data. For FY 2018, Methodist Hospital of Sacramento’s required
Minimum Charity Care amount using the three-year rolling average from FY 2015 – FY
2017 would be $3,575,851. For purposes herein, the term “Charity Care” shall mean the
amount of charity care costs (not charges) incurred by Methodist Hospital of
Sacramento in connection with the operations and provision of services at Methodist
Hospital of Sacramento. The definition and methodology for calculating “Charity Care”
and the methodology for calculating “cost” shall be the same as that used by OSHPD for
annual hospital reporting purposes. The Minimum Charity Care Amount will be
increased on an annual basis by the rate of inflation as measured by a Consumer Price
Index from the U.S. Bureau of Labor Statistics;
7. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall continue to expend a five-year average of no
less than $4,466,439 annually in community benefit services. This amount should be
increased annually based on the Consumer Price from the Bureau of Labor Statistics. In
118

 addition, the following community benefit programs shall continue to be offered for at
least five years from closing;
a.
b.
c.
d.
e.

Chronic Disease Self-Management Program;
Lutheran Social Services Homeless Housing;
Wellspace Interim Care Program;
Mercy Family Health Center (Family Practice Residency); and
Dignity Health Community Grants.

8. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall maintain its participation in the Medicare
program, providing the same types and/or levels of emergency and non-emergency
services to Medicare beneficiaries, on the same terms and conditions as other similarly
situated hospitals, by maintaining a Medicare Provider Number;
9. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall be certified to participate in the Medi-Cal
program, providing the same type, and/or levels of emergency and non-emergency
services to Medi-Cal beneficiaries;
10. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall maintain its participation in the Medi-Cal
Managed Care program, providing the same types and/or levels of emergency and nonemergency services to Medi-Cal beneficiaries, on the same terms and conditions as
other similarly situated hospitals offering substantially the same services, without any
loss, interruption of service, or decrease of quality, or gap in contracted hospital
coverage, including continuation of the following contracts:
a. Commercial Plan: Anthem Blue Cross Medi-Cal or it successor;
b. Commercial Plan: Health Net or its successor; and
c. Commercial Plan: Molina Health Plan or it successor.
11. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Methodist Hospital of Sacramento shall maintain its current city/county contracts for
the programs listed below:
a. Agreement for Provision of Specified Medical Services (Medical Indigent Services
Program); and
b. Memorandum of Understanding – Automated Vital Statistics System (AVSS)/NET.
12. Dignity Health and CHI shall commit the necessary investments required to meet and
maintain OSHPD seismic compliance requirements at Methodist Hospital of Sacramento
until January 1, 2030 under the Alfred E. Alquist Hospital Facilities Seismic Safety Act of

119

 1983, as amended by the California Hospital Facilities Seismic Safety Act (Health &
Safety Code, § 129675-130070);and
13. Methodist Hospital of Sacramento shall maintain written policies that prohibit
discrimination against lesbian, gay, bisexual, or transgender individuals.
Mercy San Juan Medical Center:
1. For at least ten years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall continue to operate as a general acute care
hospital;
2. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall maintain 24-hour emergency services at no less
than current licensure and designation with the same types and/or levels of services,
including the following:
a.
b.
c.
d.

31 Treatment Stations;
Paramedic Base Station;
Level II Trauma Center; and
Certified Comprehensive Stroke Center.

3. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall maintain the following services at current
licensure, types, and/or levels of services:
a. Critical care services, including a minimum of 45 licensed intensive care beds and
a minimum of 11 licensed coronary care beds;
b. Obstetric services, including a minimum of 32 licensed perinatal beds;
c. Intensive Care Newborn Nursery services, including a minimum of 26 licensed
neonatal intensive care unit beds;
d. Pediatric services, including a minimum of 8 licensed pediatric beds.

4. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall maintain the following services as committed to in
Exhibit L of the Ministry Alignment Agreement:
a.
b.
c.
d.
e.
120

Cardiology services and cardiac catheterization laboratory services;
Cardiovascular surgery services;
Interventional cardiology services;
Electrophysiology services;
General cardiology services;

 f.
g.
h.
i.
j.
k.
l.
m.
n.

Oncology services, including radiation therapy and outpatient chemotherapy;
Orthopedic surgery services, including total joint replacements;
General surgery services, including bariatric surgery services;
Outpatient Services – Surgery;
Nuclear medicine services;
Imaging and radiology services (inpatient and outpatient); and
Laboratory services;
Physical therapy services; and
Respiratory care services.

5. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall maintain currently provided women’s healthcare
services;
6. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall maintain a charity care policy that is no less
favorable than its current charity care policy and in compliance with California and
Federal law, and Mercy San Juan Medical Center shall provide an annual amount of
charity care equal to or greater than $5,505,792 (the “Minimum Charity Care Amount”).
Alternatively, because of the impact of Medi-Cal expansion and the ACA, the California
Attorney General could consider adjusting the required commitment to charity care
based on available data from time periods after implementation of the ACA. An example
would be to require a commitment based on a three-year rolling average of the most
recent available data. For FY 2018, Mercy San Juan Medical Center’s required Minimum
Charity Care amount using the three-year rolling average from FY 2015 to FY 2017
would be $4,357,297. For purposes herein, the term “Charity Care” shall mean the
amount of charity care costs (not charges) incurred by Mercy San Juan Medical Center in
connection with the operations and provision of services at Mercy San Juan Medical
Center. The definition and methodology for calculating “Charity Care” and the
methodology for calculating “cost” shall be the same as that used by OSHPD for annual
hospital reporting purposes. The Minimum Charity Care Amount will be increased on an
annual basis by the rate of inflation as measured by a Consumer Price Index from the
U.S. Bureau of Labor Statistics;
7. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall continue to expend no less than $5,288,729
annually in community benefit services. This amount should be increased annually
based on the Consumer Price Index from the Bureau of Labor Statistics. In addition, the
following community benefit programs shall continue to be offered for at least five
years from closing;
a. Chronic Disease Self-Management Program;
b. Lutheran Social Services Homeless Housing;
c. Wellspace Interim Care Program; and
121

 d. Dignity Health Community Grants.
8. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall maintain its participation in the Medicare program,
providing the same types and/or levels of emergency and non-emergency services to
Medicare beneficiaries, on the same terms and conditions as other similarly situated
hospitals, by maintaining a Medicare Provider Number;
9. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall be certified to participate in the Medi-Cal program,
providing the same type, and/or levels of emergency and non-emergency services to
Medi-Cal beneficiaries;
10. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall maintain its participation in the Medi-Cal Managed
Care program, providing the same types and/or levels of emergency and nonemergency services to Medi-Cal beneficiaries, on the same terms and conditions as
other similarly situated hospitals offering substantially the same services, without any
loss, interruption of service, or decrease of quality, or gap in contracted hospital
coverage, including continuation of the following contracts:
e. Commercial Plan: Anthem Blue Cross Medi-Cal or it successor;
f. Commercial Plan: Health Net or its successor; and
g. Commercial Plan: Molina Health Plan or it successor.
11. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy San Juan Medical Center shall maintain its current city/county contract for the
program listed below:
a. Base Hospital Medical Control Agreement;
b. Agreement for Provision of Specified Medical Services (Medical Indigent Services
Program); and
c. Memorandum of Understanding – Automated Vital Statistics System (AVSS)/NET.
12. Dignity Health and CHI shall commit the necessary investments required to meet and
maintain OSHPD seismic compliance requirements at Mercy San Juan Medical Center
until January 1, 2030 under the Alfred E. Alquist Hospital Facilities Seismic Safety Act of
1983, as amended by the California Hospital Facilities Seismic Safety Act (Health &
Safety Code, § 129675-130070); and
13. Mercy San Juan Medical Center shall maintain written policies that prohibit
discrimination against lesbian, gay, bisexual or transgender individuals.

122

 Mercy Hospital of Folsom
1. For at least ten years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall continue to operate as a general acute care hospital;
2. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall maintain 24-hour emergency services at no less than
current licensure and designation with the same types and/or levels of services,
including the following:
a. 25 Treatment Stations.
3. For at least five years from closing, Mercy Hospital of Folsom shall maintain the
following services at current licensure, types, and/or levels of services:
a. Obstetrics care, including a minimum of 8 licensed perinatal beds; and
b. Intensive care services, including a minimum of 8 licensed intensive care beds.
4. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall maintain the following services as committed to in
Exhibit L of the Ministry Alignment Agreement:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.

Cardiovascular services, including general cardiology;
Neuroscience services, including general neuroscience services;
Orthopedic surgery services, including total joint replacements;
General surgery services;
Outpatient Services - Rehabilitation Services;
Nuclear medicine services;
Inpatient and outpatient imaging and radiology;
Laboratory services;
Lactation services;
Psychiatric services;
Physical therapy services; and
Respiratory care services.

5. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall maintain currently provided women’s healthcare
services;
6. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall maintain a charity care policy that is no less favorable
than its current charity care policy and in compliance with California and Federal law,
and Mercy Hospital of Folsom shall provide an annual amount of charity care equal to or
123

 greater than $1,001,837 (the “Minimum Charity Care Amount”). Alternatively, because
of the impact of Medi-Cal expansion and the ACA, the California Attorney General could
consider adjusting the required commitment to charity care based on available data
from time periods after implementation of the ACA. An example would be to require a
commitment based on a three-year rolling average of the most available data. For FY
2018, Mercy Hospital of Folsom’s required Minimum Charity Care amount using the
three-year rolling average from FY 2015 – FY 2017 would be $936,615. For purposes
herein, the term “Charity Care” shall mean the amount of charity care costs (not
charges) incurred by Mercy Hospital of Folsom in connection with the operations and
provision of services at Mercy Hospital of Folsom. The definition and methodology for
calculating “Charity Care” and the methodology for calculating “cost” shall be the same
as that used by OSHPD for annual hospital reporting purposes. The Minimum Charity
Care Amount will be increased on an annual basis by the rate of inflation as measured
by a Consumer Price Index from the U.S. Bureau of Labor Statistics;
7. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall continue to expend a five-year average of no less than
$1,709,910 annually in community benefit services. This amount should be increased
annually based on the Consumer Price Index from the Bureau of Labor Statistics. In
addition, the following community benefit programs shall continue to be offered for at
least five years from closing;
a. Chronic Disease Self-Management Program;
b. Lutheran Social Services Homeless Housing; and
c. Dignity Health Community Grants.
8. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall maintain its participation in the Medicare program,
providing the same types and/or levels of emergency and non-emergency services to
Medicare beneficiaries, on the same terms and conditions as other similarly situated
hospitals, by maintaining a Medicare Provider Number;
9. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall be certified to participate in the Medi-Cal program,
providing the same type, and/or levels of emergency and non-emergency services to
Medi-Cal beneficiaries;
10. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall maintain its participation in the Medi-Cal Managed Care
program, providing the same types and/or levels of emergency and non-emergency
services to Medi-Cal beneficiaries, on the same terms and conditions as other similarly
situated hospitals offering substantially the same services, without any loss, interruption
of service, or decrease of quality, or gap in contracted hospital coverage, including
continuation of the following contracts:
124

 a. Commercial Plan: Anthem Blue Cross Medi-Cal or its successor;
b. Commercial Plan: Health Net or its successor; and
c. Commercial Plan: Molina Health Plan or its successor.
11. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall maintain its current city/county contracts for the
programs listed below:
a. Memorandum of Understanding – Paternity Opportunity Program Private
Hospital;
b. Transfer Agreement;
c. ALS Agreement;
d. Agreement for Provision of Specified Medical Services (Medical Indigent Services
Program); and
e. Memorandum of Understanding – Automated Vital Statistics System (AVSS)/NET.
12. Dignity Health and CHI shall commit the necessary investments required to meet and
maintain OSHPD seismic compliance requirements at Mercy Hospital of Folsom until
January 1, 2030 under the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983,
as amended by the California Hospital Facilities Seismic Safety Act (Health & Safety
Code, § 129675-130070); and
13. Mercy Hospital of Folsom shall maintain written policies that prohibit discrimination
against lesbian, gay, bisexual or transgender individuals.
Mercy General Hospital
1. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy General Hospital shall continue to operate as a general acute care hospital;
2. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy General Hospital shall maintain 24-hour emergency services at no less than
current licensure and designation with the same types and/or levels of services,
including the following:



20 Treatment Stations;
STEMI Receiving Center; and

3. Certified Primary Stroke Center. For at least five years from closing, Mercy General
Hospital shall maintain the following services at current licensure, types, and/or levels of
services:
a. Intensive care services, including a minimum of 46 licensed intensive care beds;
125

 b. Rehabilitation services, including a minimum of 30 licensed rehabilitation beds;
and
c. Obstetric services, including a minimum of 17 licensed perinatal beds.

4. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy General Hospital shall maintain the following services as committed to in Exhibit
L of the Ministry Alignment Agreement:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
s.

Coronary care and cardiology services;
Cardiac catheterization laboratory services;
Interventional cardiology services;
Cardiovascular surgery services;
Outpatient Services - Electrophysiology Lab;
Mercy Advanced Heart Disease Clinic;
Outpatient Services - Surgery Center;
Neuroscience services, including neurosurgery services;
Oncology services, including inpatient medical and surgical oncology services,
and radiation therapy services;
Orthopedic surgery services, including total joint replacements;
General surgery services;
Outpatient Services – Rehabilitation Services;
Nuclear medicine services;
Imaging and radiology services (inpatient and outpatient);
Laboratory services;
Physical therapy services;
Respiratory care services;
Social services; and
Speech pathology services.

5. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy Hospital of Folsom shall maintain currently provided women’s healthcare
services;
6. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy General Hospital shall maintain a charity care policy that is no less favorable than
its current charity care policy and in compliance with California and Federal law, and
Mercy General Hospital shall provide an annual amount of charity care equal to or
greater than $3,073,105 (the “Minimum Charity Care Amount”). Alternatively, because
of the impact of Medi-Cal expansion and the ACA, the California Attorney General could
consider adjusting the required commitment to charity care based on available data
from time periods after implementation of the ACA. An example would be to require a
commitment based on a three-year rolling average of the most available data. For FY
2018, Mercy General Hospital’s required Minimum charity care amount using the three126

 year rolling average from FY 2015 to FY 2017 would be $3,509,732. For purposes herein,
the term “Charity Care” shall mean the amount of charity care costs (not charges)
incurred by Mercy General Hospital in connection with the operations and provision of
services at Mercy General Hospital. The definition and methodology for calculating
“Charity Care” and the methodology for calculating “cost” shall be the same as that used
by OSHPD for annual hospital reporting purposes. The Minimum Charity Care Amount
will be increased on an annual basis by the rate of inflation as measured by the
Consumer Price Index from the U.S. Bureau of Labor Statistics;
7. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy General Hospital shall continue to expend a five-year average of no less than
$7,164,131 annually in community benefit services. This amount should be increased
annually based on the Consumer Price Index from the Bureau of Labor Statistics,
California. In addition, the following community benefit programs shall continue to be
offered for at least five years from closing;
a.
b.
c.
d.

Chronic Disease Self-Management Program;
Lutheran Social Services Homeless Housing;
Wellspace Interim Care Program; and
Dignity Health Community Grants.

8. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy General Hospital shall maintain its participation in the Medicare program,
providing the same types and/or levels of emergency and non-emergency services to
Medicare beneficiaries, on the same terms and conditions as other similarly situated
hospitals, by maintaining a Medicare Provider Number;
9. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy General Hospital shall be certified to participate in the Medi-Cal program,
providing the same type, and/or levels of emergency and non-emergency services to
Medi-Cal beneficiaries;
10. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy General Hospital shall maintain its participation in the Medi-Cal Managed Care
program, providing the same types and/or levels of emergency and non-emergency
services to Medi-Cal beneficiaries, on the same terms and conditions as other similarly
situated hospitals offering substantially the same services, without any loss, interruption
of service, or decrease of quality, or gap in contracted hospital coverage, including
continuation of the following contracts:
a. Commercial Plan: Anthem Blue Cross Medi-Cal or it successor;
b. Commercial Plan: Health Net or it successor; and
c. Commercial Plan: Molina Health Plan or it successor.

127

 11. For at least five years from the Closing Date of the Ministry Alignment Agreement,
Mercy General Hospital shall maintain its current city/county contracts for the programs
listed below:
a.
b.
c.
d.

Community Work Experience;
STEMI Designation Agreement;
Base Hospital Agreement;
Agreement for Provision of Specified Medical Services (Medical Indigent Services
Program); and
e. Memorandum of Understanding – Automated Vital Statistics System (AVSS)/NET.
12. Dignity Health and CHI shall commit the necessary investments required to meet and
maintain OSHPD seismic compliance requirements at Mercy General Hospital until
January 1, 2030 under the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983,
as amended by the California Hospital Facilities Seismic Safety Act (Health & Safety
Code, § 129675-130070); and
13. Mercy General Hospital shall maintain written policies that prohibit discrimination
against lesbian, gay, bisexual or transgender individuals.

128

 JD Healthcare ViZientm

Methodist Hospital of Sacramento License

License: 030000064
Effective: 12/31/2017
Expires: 1 2/30/2018

State of California Licensed Capacity: 329
Department of Public Health

In accordance with applicable provisions of the Health and Safety Code of California
and its rules and regulations, the Department of Public Health hereby issues

this License to
Dignity Health

to operate and maintain the following General Acute Care Hospital

Methodist Hospital of Sacramento

7500 Hospital Drive
Sacramento. CA 95823-5403

Bed Classi?cationsIServicee Other Approved Services
158 General Acute Care Basic Emergency Medical
22 Perinatal Mobile Unit - Lithotripsy
12 Intensive Care Newborn Nursery Nuclear Medicine
10 Coronary Care Occupational Therapy
10 Intensive Care Outpatient Clinics - Family Health at Mercy
104 Unspeci?ed General Acute Care Family Health Center. 7601 Hospital Drive,

Suite 103, Sacramento

Outpatient Services - Surgery at Dignity Health
Medical Plaza, 8220 Wymark Drive. Suite
103. Elk Grove

Physical Therapy

Respiratory Care Services

Social Services

Speech Pathology

Bruceville Terrace - DIP SNF of Methodist Hospital
8151 Bruceville Road
Sacramento, CA 95823-2300

Bed Classifications/Services
171 Skilled Nursing

This LICENSE is not transferable and is granted solely upon the following conditions, limitations and comments:
None

  
   

Karen L. Smith, MD, MPH 


Director and State Public Health Of?cer L/gtephanie Devlin. Manager
Refer Complaints regarding these facilities to: The California Department of Publlc Health, and Certification,
Sacramento Office, 3901 Lennane Drive, Suite 210, Sacramento, CA 95834, (918) 283-5800

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129

JD Healthcare ViZientm

Mercy San Juan Medical Center License

License: 030000063
Effective: 1231/2017

State of California ?answers? mac/230;:
Department of Public Health 

In accordance with applicable provisions of the Health and Safety Code of California
and its rules and regulations. the Department of Public Health hereby' Issues

this License to
(/11 Dignity Heal 

to maintain the following GenergiWA'c?ute Care Hospital
9111-

g: yo 2m}; - 
Many San Juan Medical Center we?)
'1


411% 
it $65Q1Coyl'e'Avenue 

9., a .. Carmichael. CA 95608-0306 .. 
Bed ClassificationWSewIcesy? 1' Other Approved fr?.
370 General Acute Care Basic Emergencyv?edlca] 
45 intensive.Car -Cardiac? Catheterizbation Laboratory Services
32 Perinatal .3: 

.w ?Cardiovascular I, 1
Narse 11:17. . *INuclear.M9 dI dne 71A VS 
iicomnaIyCare 

W3 
i Outpa?entSerVIces ED?Fastti'xr?ack Ciir'iVI/c
i 8Pediatri? Ls - ..-. .,

at
?l
- 6501,00er Avenue a; 
248 Unspecmed lGenevral??cute Care 0 at 6660? oylei
EC Cb: I Avenu?:?:u5ite100?iCanmchaei 
(I t} 3 Stiff yswai?herapy/ in,I/i
2? 13 qt?'dl . I
a r7; 3" rte/V"
A {32/1 Iii?Niel 
- This LICENSE is not transferable and' Is granted
Basic Emergency Services (Level II Traum
I Newborn Nursey (12 Level 12 Love

solely upon the foliowin
a Center)

i ii. 2 Level I)

9 conditions, limitations and comments:

Karen L. Smith, MD, MPH

Director and State Public Health Of?cer St?piianie Devlin Manager

Refer Complaints regarding these facilities to: The California Department of Pub
Sacramento District Office. 3901 Lennano Drive,

 

lie Health. Licensing and Certification,
Suite 210. Sacramento, CA 95834. (916) 263- 5800

BABY In A 

130

JD Healthcare ViZientm

Mercy Hospital of Folsom License

License: 030000372
Effective: 12/31/2017
Expires: 12/30/2018

State Of califbrnia Licensed Capacity: 106
Department of Public Health

In accordance with applicable provisions of the Health and Safety Code of California
and its rules and regulations, the Department of Public Health hereby issues

this License to
Dignity Health

to operate and maintain the following General Acute Care Hospital

Mercy Hospital of Folsom

1650 Creekside Drive
Folsom, CA 95630-3400

Bed Classi?cations/Services Other Approved Services
106 General Acute Care Basic Emergency Medical
8 Intensive Care Nuclear Medicine
8 Perinatal Outpatient Services - Radiology or Imaging
90 Unspeci?ed General Acute Care Clinic - 
Outpatient Services - Rehabilitation Services
at Rehabilitation Services, 1580 Creekside
Drive, Suite 140, Folsom
Physical Therapy
Respiratory Care Services

This LICENSE is not transferable and is granted solely upon the following conditions. limitations and comments:

 

None
Karen L. Smith, MD, MPH 
Director and State Public Health Of?cer Stephaniebevlin. Manager

Refer Complaints regarding these facilities to: The California Department of Public Health, Licensing and Certi?cation.
Sacramento District Office. 3901 Lennane Drive. Suite 210. Sacramento, CA 96834. (916) 283-5800

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131

JD Healthcare ViZientw

Mercy General Hospital License

License: 030000062
Effective: 133mm 7
Expires: 125012018

State Of california Licaneed Capacity: 419
Department ofPu blic Health

In accordance with applicable provisions of the Health and Safety Code of California
and its rules and regulations, the Department of Public Health hereby issues

this License to
Dignity Health

to operate and maintain the following General Acute Care Hospital

Mercy General Hospital
I. 4001 Street
Sacramento, CA 95319-3625
Bed Classi?cationsiServtces Other Approvedsiarvices
419 General AWE Care Basic Emergency Medical
46 intensive Care cardiac Catheterization Laboratory Services
30 Rehabilitation - - Cardiovascular Surgery 
17Perinatal Nuclear Medicine
326 Unspecified General Acute Care . . I Occupational Therapy-

Outpatient Services at Mercy Advanced Head
Disease Clinic 3310 Street Sacramento
Outpatient Services - Electrophysiology Lab at
I .3941 J. Street Lower Level. Sacramento
outpatient Services- Rehabilitation Services
at Greenback Lane, Suite 110. Citrus
- Heights I -.
. Outpatient Services Surgery Center at 3941 
Street Lower: Level Sacramento
Physical Therapy-
Physical Therapy. at Alhambra Bivd.
Suite 102 Sacramento
Radiation Therapy 
Respiratory Care Services .
. Social Services 
. Speech Pathology 

This LICENSE is not transferable and is granted solely upon the following conditions. limitations and comments:
None

Karen L. Smith, MD, MPH

Director and State Public Health Of?cer Stephenie Devlin. Manager
Refer Complaints regarding these faci?ties to: The California Department of Public Health, Licensing and Certi?cation,
Sacramento District Of?ce, 3901 Lennane Drive, Sulte 2'10. Sacramento. CA 95834. (518]: 263-5800

 

 

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132