1. Title Slide Alternative 1 Subtitle Downtown Louisville Medical Campus

2. Jewish Hospital Outpatient Care Center Rudd Heart & Lung Institute Ambulatory Care Center University of Louisville Hospital James Graham Brown Cancer Center Frazier Rehab Institute Louisville Medical Campus 2

3. Academic Hospital and Primary Teaching Hospital for the University of Louisville Medical School- Managed by KentuckyOne Health/Catholic Health Initiative. Nationally distinguished areas of service include trauma care, stroke care, cancer care, radiology/diagnostic imaging, and high risk obstetrics. Other specialties include robotic surgery, epilepsy care, psychiatric services and palliative care. Faculty Appointment required to serve on medical staff. Separate corporate entity from School of Medicine. University of Louisville Hospital 3

4. Structure of Incentives 4 Legal: Medical Staff Structure dictates incentives be based on quality improvement. No discussion of volumes or referrals. Operational: Management of the conversations and determination of data to be measures and timing of payout. What is the right dollar amount that doesn’t lead to financial hardship if the metrics are not achieved. Use real data that can be captured easily – agree on the data source and target before you start. Expect tension before and during measurement – that’s a good thing!

5. Track Track Weight Goal WeightDescription2009 Goal First Quarter Result Goal Score Goal Range Current Score Quality65% 13.00% 45 minutes from door to ready for cath lab for STEMI patients. 96%90% 5 or greater 5 480%89% 370%79% 260%69% 150%59% 13.00% Percent of pneumonia patients whose initial emergency room blood culture is ordered prior to the administration of the first hospital dose of antibiotics. 100% 5 -- 5 496%99% 392%95% 288%91% 184%87% 13.00% ED - Community Acquired Pneumonia protocol followed for all appropriate patients. 100% 5 -- 5 498%99% 396%97% 294%95% 192%93% 13.00% For non "room 9" patients ER physicians will assure that an updated ED treatment course is available in the T- System when patients leave the emergency department. 95% 5 or greater 5 493%94% 391%92% 289%90% 187%88% 13.00% Reduce hospital admission on the second visit to the ER.5% 5 or less 5 45%10% 3 Overall second visit admit rate less than 10% 2 Overall second visit admit rate greater than 10% 1 Overall second visit admit rate greater than 12% Growth15% 15.00% Decrease or stabilize left without being seen rate.7.50%2.03% 57.50%or less 5 48.00%7.60% 38.50%7.90% 29.00%14.00% 19.10%16.00% Service20% 20.00% Improve Emergency Department Patient Satisfaction in the "Doctors" category by increasing the mean Press- Ganey score to equal or greater than the Emergency Department overall satisfaction. 0 % variance -2 % 54or greater 2 423 301 2-2 1-3-4 Total 100% Total Score4.40 Revised:29-Jun-10Total PFP Payment 85% Sample Score Card 5

6. Building Relationships 6 “Our relationships with people are formed by small moments…” This is about improvement – not control. Be flexible and forgiving early this is a long term strategy. Find the motivation, listen for what is important to the chair. What can achieving the metric bring to the department? Always remember it is less about dollar and cents and more about finding common alignment and a process to continually improve.

7. Understanding this might be a new concept. Revolutionary improvement is great – incremental improvement moved you forward as well. Spending more time on the numbers and less time on how to improve together. Be sure you are clear with the department chair regarding expectation. What to watch out for 7