VOLUNTARY EVENT DISCLOSURE COVER SHEET

Transcription

1 VOLUNTARY EVENT DISCLOSURE COVER SHEET This cover sheet and accompanying "voluntary event disclosure" will be sent to the MSRB, pursuant to the Disclosure Dissemination Agent Agreement dated as of January between the Issuer and DAC. Issuer' s and/or Other Obligated Person' s Name: NYU Hospitals Center ("NYUHC") Nine-Digit CUSIP Number(s) of the bonds to which this notice relates: Dormitory Authority of the State of New York NYU Hospitals Center Revenue Bonds, Series 2011A, $130,930,000, Dated: January25, 2011 : S9, T7, U4, V2, VV0, X8, Y6, Z3, A7, B5, C3, D1, E9, F6, G4, H2, J8, K5, L3 Dormitory Authority of the State of New York NYU Hospitals Center Revenue Bonds, Series 2007B, $94,150,000, Dated: December 5, 2007: VVR8, VVS6 Dormitory Authority of the State of New York NYU Hospitals Center Revenue Bonds, Series 2007A, $165,300,000, Dated: February 6, 2007: CU3, CV1, CVV9, CX7, CY5, CZ2, DA6 Dormitory Authority of the State of New York, NYU Hospitals Center Revenue Bonds, Series 2006A, $94,590,000, Dated: October 4, 2006: 64983QY37, 64983QY45, 64983QY52, 64983QY60, 64983QY78, 64983QY86 NYU Hospitals Center Revenue Bonds, $52,200,000, Series 2000D (Auction Rate Securities), Dated: April 15, 2000: 64983VVV37 NYU Hospitals Center Taxable Bonds, $250,000,000, Series 2012A, Dated July 31, 2012: 62952EAA5 NYU Hospitals Center Taxable Bonds, $350,000,000, Series 2013A, Dated July 24, 2013: 62952EAB3

2 Number of pages attached: 26 Description of Voluntary Event Disclosure (Check One): 1. "amendment to continuing disclosure undertaking;" 2. "change in obligated person;" 3. "notice to investors pursuant to bond documents;" 4. "certain communications from the Internal Revenue Service;" 5. "secondary market purchases;" 6. "bid for auction rate or other securities;" 7. "capital or other financing plan;" 8. "litigation/enforcement action;" 9. "change of tender agent, remarketing agent, or other on-going party;" 10. "derivative or other similar transaction;" and 11. X "other event-based disclosures." I hereby represent that I am authoriz issuer or its agent to distribute this information publicly: Name: Michael T. Burke Title: Senior Vice President and Vice Dean. Chief Financial Officer Digital Assurance Certification, L.L.C. 390 N. Orange Avenue Suite 1750 Orlando, FL Date: January

3 JP Morgan Healthcare Conference Organizational Update: January 2014 Michael Burke, SVP and Corporate CFO NYU Hospitals Center, Vice Dean for Financial Affairs, NYU School of Medicine

4 Cautionary Statement Regarding Forward-Looking Statements Certain statements included, incorporated by reference or verbally discussed constitute projections or estimates of future events, generally known as forward-looking statements. These statements are generally identifiable by the terminology used such as plan, expect, estimate, budget or other similar words. The achievement of certain results or other expectations contained in such forward-looking statements involves known and unknown risks, uncertainties and other factors which may cause actual results, performance or achievements described to be materially different from any future results, performance or achievements expressed or implied by these forward-looking statements. NYUHC does not plan to issue any updates or revisions to those forward-looking statements if or when changes in its expectation, or events, conditions or circumstances on which such statements are based occur. NYUHC s operations are subject to various risks, including without limitation those risks described under the heading, Bondowners Risk and Matters Affecting the Health Care Industry in the Official Statement relating to NYU Hospitals Center Taxable Bonds, Series 2013A, available at If any of these or other risks occur, or if the assumptions underlying any of the statements set forth in this document prove incorrect, the actual results may significantly differ from those expressed or implied by such statements. NYUHC does not update forward-looking statements retrospectively. Such statements are valid on the date of publication and can be superseded. Note: Cover image photograph of main facility includes NYU School of Medicine Facilities. 2

5 Agenda Ø What makes NYU Langone Medical Center ( NYULMC ) a unique organization? Ø What are the competitive dynamics in the Manhattan and NYC regional healthcare environment? Ø How is NYULMC positioning for success in the changing healthcare environment? Ø How has NYUHC performed on key financial and operational metrics? 3

6 Section 1: An Integrated Vision Presentation Title Goes Here 4

7 Unique Structure for NYU Langone Medical Center New York University NYU Langone Medical Center Ø NYULMC is an integrated academic medical center in midtown Manhattan with outpatient centers across the region: Ø Tisch Hospital (546 beds). Ø Hospital for Joint Diseases (157 beds). Ø Ambulatory care network. School of Medicine (including Faculty Group Practice) Key: Member of the Obligated Group Sole member Unincorporated division of New York University NYU Hospitals Center CCC550 Note: Neither New York University nor its School of Medicine are obligated with respect to NYUHC s Bonds or commercial debt. No assets or revenues of New York University or its School of Medicine are pledged to secure or available to pay debt service with respect to NYUHC s debt obligations. CCC550, NYU Hospitals Center s wholly owned captive insurance company, is also not obligated with respect to NYUHC s debt obligations and no assets or revenues of CCC550 are pledged to secure or available to pay debt service with respect to NYUHC s debt obligations. Ø NYU Physician Network including NYU School of Medicine ( NYUSM ) Faculty Group Practice and private physicians: Ø 2,300+ physicians. Ø Over 100 medical practices. Ø NYULMC is a virtual entity with one management team and one board of trustees making the key decision across the hospital and school of medicine. Ø NYULMC FY 2013 operating revenues: $3.3 billion (including NYUHC ~ $1.9 billion) 5

8 Commitment to the Pursuit of Excellence Investment in Technology Ø EPIC - First fully integrated Clinical and Billing system in New York Ø Performance Dashboards Ø Data Center - Key infrastructure component for the future Campus Transformation Ø Broad System Implementation Ø PeopleSoft - New Enterprise Resource Planning System Ø Enterprise Data Warehouse & Business Intelligence Dedication to Clinical Quality Ranked #14 in the nation on the Best Hospitals Honor Roll with 12 nationally ranked specialties Ranked #1 for surgical care among the nation s academic medical centers Ranked #1 for Patient Safety and Quality. Recipient of the 2013 Quality Leadership Award 6

9 Section 2: Competition Presentation Title Goes Here 7

10 NYC Metropolitan Healthcare Competition Ø Manhattan competition also impacted by regional health systems: Ø Montefiore Medical Center (Bronx, NY) Ø NS-LIJ (Long Island, NY) Ø Catholic Health Services (Long Island, NY) Ø Hackensack Medical Center (New Jersey) Ø Atlantic Health System (New Jersey) Ø Barnabas Health (New Jersey) Ø Recent NYC system mergers: Ø Mount Sinai-Continuum Ø NS-LIJ Lenox Hill Hospital 8

11 Clinical Care Delivery Shifting to Outpatient Ø NYC Metropolitan hospitals and systems have begun to focus on shifting delivery of care to an ambulatory setting. Ø NYUHC s pro-active strategy focusing on ambulatory and physician expansion has resulted in an overall change to its net patient revenue base. (1/2) NYUHC Inpatient & Outpatient Revenue Base FY 2010 vs. FY 2013 FY % 40.3% Outpatient Inpatient (1/2) FY % 50.9% Outpatient Inpatient (1) Peer group data sourced from Cleverley + Associates. (2) Peer group includes: Memorial Sloan-Kettering, Lenox Hill Hospital, Harlem Hospital Center, Hospital for Special Surgery, NY Eye and Ear Infirmary, Bellevue Hospital Center, Metropolitan Hospital Center, New York Downtown Hospital, New York-Presbyterian Hospital, North Shore LIJ, Mount Sinai Hospital, Beth Israel Medical Center and St. Luke s Roosevelt Hospital. 9

12 Section 3: Positioning for Success Presentation Title Goes Here 10

13 Positioning for Success in a New Environment Ø Expanding Inpatient and Ambulatory Care Facilities Ø Expanding Physician Network Across Region Ø Strategic Focus on Key Patient Populations Ø Contracting Structures Built on Clinical Integration Ø Efficient Management of Patient Populations Ø Leveraging Technology for Quality and Financial Improvement Ø Flexible Funding to Support Strategic Investments in the Future Ø Philanthropic Success to Support Continued NYULMC Growth 11

14 Expanding Inpatient and Ambulatory Facilities in Manhattan Expanded ambulatory presence in the last three years: Ø Musculoskeletal Center (110,000 sq. ft.) Ø Ambulatory Center (300,000 sq. ft.) Ø Outpatient Surgery Center (18,000 sq. ft.) Ø An extension clinic at NYUSM s Joan H. Tisch Center for Women s Health Ø Tisch Center for Men s Health Ø NYU Langone Internal Medicine The Miller Practice Affiliated Hospitals (Manhattan and Brooklyn): Ø Bellevue Hospital Center PERELMAN Ø Gouverneur Healthcare Services Ø New York Harbor Veterans Affairs Medical Center Ø Woodhull Hospital Medical Center 12

15 Growing Physician Presence Across Region Expanded geographic presence beyond Manhattan through new physician relationships: Ø Outpatient care centers (i.e. Oncology, Orthopaedics) Ø Specialist outreach programs Acquired and opened outpatient centers outside of Manhattan: Ø Brooklyn Endoscopy and Ambulatory Surgery Center Ø Hudson Valley Cardiology (Westchester, NY) Ø Columbus Medical Center (Queens, NY) 13

16 Broadening Physician Network Ø NYULMC combines employed physicians with partnership structures for nearly 2,400 physicians Ø 1,100 employees of NYUSM or NYUHC Ø 1,300 private practice physicians Ø Physician Growth ,388 1,838 1,892 2,001 2,056 2,138 Ø Expanding new physician relationships in key clinical areas: CY 2008 CY 2009 CY 2010 CY 2011 CY 2012 CY 2013 Ø Internal medicine; cardiovascular disease; anesthesiology; pediatrics; neurology and neurosurgery; pulmonary/critical care; orthopaedic surgery; ophthalmology and pediatrics 14

17 l 1 Strategic Focus on Key Patient Populations - WESTCHESTER ~-,... ' (~. " I I ' -xairfield \. ' ~ "' I..,. I 4 ' HAVEN,., ; SUFFOLK Total Unique Patients= 13,581 l NYU Langone '--MEDICAL CENTER Note: The primary and secondary service areas collectively represent 75% of the unique inpatients in FY2012, with the primary and secondary service areas accounting for 50% and 25%, respectively. 2 Tisch & HJD Elective Unique Inpatie Service Area ~ Pnmary Sea:lndary Excludes: Newborns, OB, Emergency and Urgent Admits, Psychiatry, and Rehab. 15

18 Risk Contracts to Build on Integrated Care Model BPCI: Bundled Payments for Care Improvement (Medicare demonstration project) Selection of Epic as Enterprise-Wide EMR 2013 Jan - Creation of NYUPN Clinically Integrated Network July - Creation of Network Integration Team Oct - NYULMC is selected as a demonstration site Medicare released the Bundled Payment Request for Application Selection of NYULMC s Health Information Exchange (HIE) ACA enacted Creation of Payment Reform Steering Committee Creation of the Payment Reform Team 2006 Conceptual Planning of Clinically Integrated Network and Health Information Technology Strategy Jan Go-live with BPCI Phase 1 Oct - Go-live with BPCI Phase 2 Oct - Go-live with 1 st commercial ACO Shared Savings arrangement 16

19 Managing Patient Populations Efficiently Ø CIGNA and United: 125,000 patients with over $700 million in annual cost of care in shared savings or full risk arrangements (as of January 2014) Ø NYUHC utilization rate of attributed patients less than market: inpatient days, admissions, readmissions, ER visits, ancillary services. Commercial Insurance Population Payor 2012 Inpatient Utilization NYULMC Days / 100 Other Providers Market Days / 100 NYULMC Performance versus Other Market Providers Index Cigna % United % Oxford % Note: 2012 inpatient utilization data provided by each respective payor. 17

20 Leveraging Technology for Quality and Financial Improvement Ø EPIC First fully integrated clinical system in NY market Ø Implementation completed in January 2013 Ø PatientSecure & MyChart: realtime access to medical records, scheduling information Ø Clinical pathway for CMS standards Ø Revenue cycle initiatives averaged $5 million/month in incremental revenue Performance Metrics/Dashboard Reporting Ø PeopleSoft Enterprise resource platform integrating supply requisitioning, ordering process, and enhanced financial reporting capabilities Ø Disaster Recovery Centers (NJ, PA) 18

21 Flexible Funding to Support Strategic Investments in the Future Ø Liquidity: Balance sheet reserves provide operating flexibility. Ø Historically have invested $10 million per month to build operating reserves. Ø As of November 2013, $497 million of unrestricted assets set aside for operating flexibility. Ø Taxable Funding: Fixed rate bonds and lines of credit for quick access to fund capital plans and physician practice acquisitions: Ø Taxable fixed rate debt of $600 million allows for flexibility in use and timing of funding projects. Ø $500 million of lines of credit capacity; $100 million currently drawn. Ø Philanthropy: Continued support by NYC community for combined medical center enterprise. Continued progress on NYUHC Campus Transformation Project to upgrade inpatient and expand outpatient services. 19

22 Philanthropic Success to Support Continued NYULMC Growth Total NYULMC Support FY (2) YTD Cumulative Philanthropy Raised: $1.51 billion $600 $500 $508 Commitments & Outright Gifts $400 Cash $300 $200 $185 $198 $169 $124 $194 $205 $155 $139 $208 $198 $243 $141 $125 $100 $0 FY08 FY09 FY10 FY11 FY12 FY13 FY14 (1) Includes combined gifts to NYUHC and NYUSM. (2) FY 2014 YTD information as of December 31, 2013 and is unaudited. 20

23 Support from the Community for the NYULMC Vision Perelman Pledges $50 Million to New York Hospital NY Times (December 19, 2013) Chang W. Lee/The New York Times NYU Langone Medical Center s emergency department had to close after Superstorm Sandy last year. 21

24 Section 4: Performance Update Presentation Title Goes Here 22

25 Financial and Operational Performance Update Ø Since 2007, NYUHC rating upgrades: Baa3/BBB+/BBB+ to A3/A-/A- Ø FY 2013 performance impacted by Superstorm Sandy Ø Inpatient facilities at Tisch Hospital closed for 60 days Ø Services at Hospital for Joint Diseases continued, with 7-day operations Ø Outpatient facilities and majority of physician offices open throughout period Ø Status Update: Ø FEMA initial recovery monies received $179.3 million to date; continuing calculations on funding recovery and mitigation efforts Ø Continuing conversations with commercial insurance companies and NIH Ø Operations restored throughout campus, with the exception of ED Ø Urgent Care Center within Tisch Hospital Ø New, expanded ED scheduled to open in Spring

26 NYUHC Financial Performance ($000) Fiscal Year Ended August 31, (Audited) Three Months Ending November 30, (unaudited) (3) 2013 Net Patient Service Revenue $1,625,839 $1,830,158 $1,662,617 $385,837 $481,253 Other Operating Revenue 75, , , ,822 79,118 Total Operating Revenue 1,701,219 1,971,445 1,931, , ,371 Total Operating Expenses 1,515,456 1,722,693 1,884, , ,389 Gain from Operations 185, ,752 47,808 33,728 52,982 Other (1) 460 (1,803) (41,252) (31,847) 5,981 NYUSM Mission Support (45,000) (27,750) (35,735) (35,735) (22,500) Excess (deficiency) of Revenue Over Expenses 141,223 $219,199 $(29,179) $(33,854) $36,463 Other changes in unrestricted net assets (2) 21,551 (94,567) 169,200 10,306 8,995 Net increase (decrease) in unrestricted net assets $162,774 $124,632 $140,021 $(23,548) $45,458 (1) FY 2013 amount consists of ($33.7 million) in impairment on disposal of property, plant and equipment related to Superstorm Sandy and other non-storm related disposals and ($7.6 million) investment return on underlying asset portfolio. (2) Other changes in unrestricted net assets includes valuation changes to pension and postretirement obligations and contributions/net assets released for capital acquisition. (3) Superstorm Sandy occurred on October 29, Inpatient services at Tisch Hospital were closed for 60 days and resumed on December 27, An Urgent Care Center has been operating in absence of a functioning Emergency Department. Thus, results for FY 2013 (inclusive of the three months ended November 30, 2012) include materially reduced operations. 24

27 NYUHC Financial & Volume Metrics Operating Margin (2) EBIDA Margin (2) Cash to Debt (%) (2/3) 12.5% 10.9% 12.6% 6.7% 9.5% 17.8% 15.8% 17.6% 8.4% 12.5% 16.0% % FY10 FY11 FY12 FY13 Nov-12 Nov-13 FY10 FY11 FY12 FY13 Nov-12 Nov-13 FY10 FY11 FY12 FY13 Nov-12 Nov-13 Days Cash on Hand (1/2) Outpatient Visits (2) Discharges (2) , , , ,770 37,408 37,929 38,045 26,676 63,381 72,823 6,540 7,998 FY10 FY11 FY12 FY13 Nov-12 Nov-13 FY10 FY11 FY12 FY13 Nov-12 Nov-13 FY10 FY11 FY12 FY13 Nov-12 Nov-13 (1) Based on Master Trust Indenture methodology. (2) Superstorm Sandy occurred on October 29, Inpatient services at Tisch Hospital were closed for 60 days and resumed on December 27, An Urgent Care Center has been operating in absence of a functioning Emergency Department. Thus, results for FY 2013 (inclusive of the three months ended November 30, 2012) include materially reduced operations. (3) FY 2013 & November 2013 figures above are inclusive of NYUHC s Series 2013A $350 million taxable bond issuance. 25

28 NYULMC Campus Transformation Update* Expand NYULMC patient care, research and education footprint to 3.5 million sq. ft. of facility space Ø Tisch Hospital elevator/lobby renovation - completed April 2013; 100% funded by philanthropy Ø Energy Building supply electricity to First Avenue campus - construction FY Ø Science Building construction - NYUSM research facilities; University funded; construction FY (300,000 sq. ft.) Ø ED Renovation Tisch Hospital; expected to open Spring 2014 (change from 6,900 to 16,900 sq. ft.) Ø Kimmel Pavilion new 22-story clinical pavilion on the First Avenue Campus; expected construction FY (830,200 sq. ft.) * Artist rendering. 26