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Strategic Initiative with
and
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Partnership Benefits for Bert Fish Medical Center and South East Volusia County
Health Management’s Mission of Enabling America’s Best Local Healthcare – Our focus is supporting South East Volusia communities Health Management’s state wide presence in Florida and locally on the East Coast connecting physicians and hospitals systems like Bayfront, Shands, and Orlando Health Health Management’s results for being a leader in both quality driven health care and healthy operations 2
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Bert Fish Medical Center Proposal Highlights
Health Management leases assets and operations of Bert Fish Medical Center for $50,000,000 in cash, spends at least $40 million in capital spending and offers Joint Venture option which includes 50/50 Governance Pay annual property taxes like all other businesses and end community health care tax after 7 years All staff employees stay at same title and pay Bert Fish Medical Center keeps its charity care policy and mission to serve the poor Clinical Affiliation with Orlando Health
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Enabling America’s Best Local Health Care
Mission and Vision Gary Newsome President and Chief Executive Officer About Health Management Mission, Vision, and Values Quality Enabling America’s Best Local Health Care
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ENABLING AMERICA’S BEST LOCAL HEALTH CARE.
Guiding Principles PEOPLE SERVICE QUALITY INNOVATION FINANCE GROWTH MISSION: ENABLING AMERICA’S BEST LOCAL HEALTH CARE. We are servant leaders. We do the right thing. We don’t settle.
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About Health Management
One of world’s most admired companies in Health Care No. 1 company in Quality of Products / Services No. 1 in Social Responsibility 70 facilities in 15 states +40,000 Associates +10,000 Physicians A focus on mid-sized communities Located primarily in the Southeastern U.S. including 22 hospitals in Florida Strong presence in markets with high retirement populations Remove colors in states we are not in like California and Northeast States with Health Management Presence Not-for-profit Joint Ventures / Affiliations
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Florida Network of Hospitals
Shands: Lake Shore, Live Oak, Starke Bert Fish Medical Center Wuesthoff - Rockledge Bayfront Medical Center Wuesthoff - Melbourne Need adjustment and updates for FL and HMA columns Add Sebastian identification Sebastian River Health Management Hospitals (FY 2011) 22 (FL) Total Beds 2,998 Admissions 132,000 Surgeries 116,000 ER Visits 575,000 Net Revenue $2.08B St. Cloud RMC / Orlando Health
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Health Management Associates Local Hospitals, National Recognition
58 hospitals/health systems are Joint Commission accredited and have received The Gold Seal of ApprovalTM. 41 hospitals/health systems were recognized as Top Performers on Key Quality MeasuresTM by The Joint Commission. 7 hospitals/health systems are certified as Primary Stroke Centers by The Joint Commission. 18 hospitals/health systems have received chest pain center accreditation by the Society of Cardiovascular Patient Care (formerly known as the Society of Chest Pain Centers).
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Vision for Nursing: Perspective from Six Pillars at Health Management
People Clinical Leader Program Development of ACNO Program CNE Orientation and Development CNE Annual Conference National Nursing Leadership Group Service and Quality Alignment with disciplines throughout the company to enhance quality outcomes Nursing leads Corporate Patient Safety Committee Nursing Sensitive Scorecard Patient Safety Scorecard Disseminate best practices through various mechanisms Development of local collaborative interdisciplinary team model
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Information Technology Integration
Base system integrates with existing platforms including Meditech Hospital Base system integrates with other ancillary, billing, and financial systems with minimal disruption Physician Clinics Athena Health for EMR and practice management systems Meaningful Use – Fully implemented in 2012
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Bert Fish Medical Center Strategy
Kathy Burke Division CEO South Florida HMA East Coast Network Market Share Opportunity Quality Outcomes Managed Care and Accountable Care Business Plan
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Health Management Associates Local Hospitals, National Recognition
Florida Recognition Six hospitals/health systems (seven locations) are certified as Primary Stroke Centers by AHCA (Agency for Health Care Administration). Five hospitals are certified as Primary Stroke Centers by The Joint Commission. Three hospitals/health systems (three locations) have received chest pain center accreditation by the Society of Cardiovascular Patient Care; one hospital with chest pain accreditation by AHCA 13 hospitals were recognized as 2011 Top Performers on Key Quality MeasuresTM by The Joint Commission.
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Health Management Associates Local Hospitals, National Recognition
Florida Medical Quality Assurance Inc. - Patient Safety Award First and only Certification Gynecological Surgical Center of Excellence in Florida; Only comprehensive stroke center in SW Florida HealthGrades: America’s Best 100 Hospitals, Distinguished Hospital Award for Clinical Excellence 2010, 2011, 2012 Blue Distinction for Hips and Knees by Florida Blue (2012); Breast Imaging Center of Excellence by the American College of Radiology (2012) Get With the Guidelines Stroke Gold Plus Award and Heart Failure Silver Award
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Health Management in Florida’s East Coast
Rockledge Melbourne Sebastian Health Management Hospitals Admissions Surgeries ER Visits Net Revenue Wuesthoff - Rockledge 12,707 7,926 37,348 $206.4M Wuesthoff - Melbourne 5,318 6,115 21,231 $114.8M Sebastian Regional 4,660 5,591 19,281 $ 81.6M 14 14
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Health Management East Coast Physician Network
A Different Business with Different Metrics requiring Different Leadership Provide physicians with viable best practice options Over 1,500 medical staff physicians 113 physician & midlevel associates More than 375 associates 64 locations throughout Space Coast 350,000 annual patient encounters $59.2 Million Net Revenue
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Patient Egress from South East Volusia
Nearly 70% of patients from South East Volusia county leave the area for patient care services Hospital PSA/SSA Bert Fish Medical Center 31.7 Halifax Health Med Ctr 34.5 Florida Hospital Memorial 11.9 Halifax Health Port Orange 8.7 All Others 13.2 Source: Florida inpatient data Jan 2011-Dec 2011 The Nielsen Company & Thomson Reuters
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Health Care Quality Data Opportunities for Improvement
Risk-Adj Mortality Composite%* Core Measures Mean Percent* HCAHPS Score % Top Box** Data source accessed Feb 21, 2013 ** Data source accessed Feb 21, 2013 Sources: * Whynotthebest.org ** Hospitalcompare.com 2/21/13
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Improving Quality and Customer Satisfaction at Bert Fish Medical Center
Bench mark quality and operations results for hospital and medical staff with 70 other hospitals and 10,000 physicians Collaborate with Health Management’s Florida hospitals for best practices in quality and operations Adopt advanced Clinical Protocols from Orlando Health and Shands Healthcare in Chest Pain and Stroke to expand facility services
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Managed Care – Keeping Bert Fish Independent and Connected
Strategic Responses to New Payment Methodologies Value Based Purchasing Hospital-Physician Bundling Pay-for-Performance Shared-Savings Model Partner with PCPs Deliver preventive & chronic disease management Reduce utilization Implement evidence base guidelines Disease Registries Care Managers Degree of Management Challenge Standardize devices Implement care maps Reduce orders and consults Engage physicians Standardize care processes Engage patients Track and analyze performance Leverage physician incentives Actions needed under all payment reforms Source: Advisory Board Provider Cost Accountability
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Bert Fish Medical Center Business Strategy
Adding Bert Fish to Health Management’s Statewide and Local Insurance Plan Networks including future ACOs with Orlando Health and Shands Healthcare Establish large network of Primary Care Physicians including private and employed physicians and free standing ERs North and South of Bert Fish Medical Center Enhance Service Lines – Capital Spending and Physician Recruitment Cardiology – Expand and Market Chest Pain Center Stroke – Expand and Market Stroke Center Surgery – Add robotics services for Orthopedics and daVinci
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Enabling America’s Best Local Health Care
Partnership Proposal Business Terms Joint Venture Option Governance Pete Lawson Executive Vice President Enabling America’s Best Local Health Care
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Bert Fish Medical Center Proposal Highlights
Health Management leases assets and operations of Bert Fish Medical Center for $50,000,000 in cash, spends at least $40 million in capital spending and offers Joint Venture option which includes 50/50 Governance Pay annual property taxes like all other businesses and end community health care tax after 7 years All staff employees stay at same title and pay Bert Fish Medical Center keeps its charity care policy and mission to serve the poor Clinical Affiliation with Orlando Health
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Estimated Flow of Funds to SE Volusia Hospital District
Cash From Lease Payment $50,000,000 Plus Inventory and Pre-Paids ,600,000 Total Cash From HMA $52,600,000 +Plus Current Assets ,200,000 +Plus Limited and Other Assets ,500,000 Less Current Liabilities (12,600,000) Long Term Debt (21,500,000) Net Proceeds Following Transaction $50,200,000 Notes: August 31, 2012 unaudited balance sheet Pension obligation not required to be paid off at closing
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Bert Fish Medical Center Governance
Advisory Board permanent seats include designated: One (1) Southeast Hospital District Member One (1) Bert Fish Foundation Member Bert Fish Medical Center Advisory Board Hospital Management Teams Medical Staffs
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Bert Fish Medical Center Advisory Board
Comprised of Local Community Leaders, Physician Representatives and Hospital CEO Typically comprised of 9-13 members: 60% lay members and 40% physicians One (1) permanent member of the District and one (1) from the Bert Fish Foundation Establishes strategic direction Oversight for regulatory compliance (JCAHO, State, CMS) and patient safety Ensures quality of care and Medical Staff credentials Collaborates on operational objectives Serves as community liaisons and communication champions
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Health Management Not-for-Profit Partnerships
Clinical Component Access to Teaching Center Physicians Disease Management Protocols Clinical Trials Clinical Care Guidelines Telemedicine Business Component Common Branding and Shared Logo Physician Recruitment Service Expansion Capital Spending Network Platform
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Joint Venture Option – 80/20 Ownership and Equal Governance
SEVHD receives cash and leases BFMC assets and operations to HMA and New Not For Profit holds 20% Health Management Associates SEVHD – New Not For Profit BFMC, LLC Creates BFMC, LLC which holds assets and operations of BFMC Health Management contributes cash and receives 80% interest of BFMC, LLC Health Management manages LLC SEVHD receives accelerated lease payment and new NFP holds 20% interest of BFMC, LLC SEVHD maintains equal governance with Health Management of BFMC, LLC Equal Governance LLC Ownership Governance HMA 80% 50 SEVHD 20% 27
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Bert Fish Medical Center, LLC Board of Directors Governance
Comprised of 4 Health Management and 4 SE Volusia Hospital District Members governing jointly Major, Majority, and Unanimous Decision Rights detailed in Operating Agreement including: Annual Operating and Capital Budgets Acquisition of other businesses Capital calls Debt defeasement or addition Distribution amounts New Member additions Dissolution and Unwinds Puts and Calls
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Estimated Partnership Flow of Funds to SE Volusia Hospital District
Cash From Lease Payment $50,000,000 Plus Inventory and Pre-Paids ,600,000 Total Cash From HMA $52,600,000 +Plus Current Assets ,200,000 +Plus Limited and Other Assets ,500,000 Less Current Liabilities (12,600,000) Long Term Debt (21,500,000) -Less 20% ownership of Joint Venture (10,500,000) Net Proceeds Following Transaction $39,7000,000 Notes: August 31, 2012 unaudited balance sheet Pension obligation not required to be paid off at closing
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Ending Health Care Tax (HMA) v. Keeping Tax (Halifax)
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Partnership Benefits for Bert Fish Medical Center and South East Volusia County
Health Management’s Mission of Enabling America’s Best Local Healthcare – Our focus is supporting South East Volusia communities Health Management’s state wide presence in Florida and locally on the East Coast connecting physicians and hospitals systems like Bayfront, Shands and Orlando Health Health Management’s results for being a leader in both quality driven health care and healthy operations 31
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Discussion and Feedback
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Partnership References
Sherrie Sitarik – CEO Orlando Health Orlando, FL (407) Tim Goldfarb – CEO Shands Healthcare Gainesville, FL (352) James Keaton, MD - Vice-Chancellor University of Mississippi Medical Center (601) David Knowiski – VP of Finance Catholic Health Partners Cincinnati, OH (513) Bruce Lawrence – CEO Integris Health Oklahoma City, OK (405) Steve Dupre – Vice Chairman Bayfront Medical Center St. Petersburg (727) 33
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Case Study: University of Florida / Shands Healthcare Partnership
Health Management Invested Capital in Yr 1: $6M Public Hospital Authority contributed additional $2M for renovations Renovated ICU Renovated first floor da Vinci robotic surgery Open MRI New Services Recruited 16 new physicians Live Oak - Cardiology Starke – General Surgery, Gyn Lake Shore – Interventional Radiology, Neurology, Orthopedics Shands Lake Shore Regional Medical Center Health Management acquired 60% ownership in 2010 Shands Lake Shore, Live Oak, and Starke Both organizations share governance equally Health Management manages the partnership State wide Chest Pain and Stroke programs 34
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Case Study: St. Cloud Regional Partnership
Capital Invested ($16M since ‘06) Land Acquisition for MOB (4.56 acres) GE 64-slice CT Scanner OR Expansion: 4 MIS ORs ER Renovation/New Fast Track Digital Mammography Da’Vinci Robotic Surgery New Services Recruited 24 new physicians (‘09-12) Wound Care w/ HBOT ENT, Ophthalmology & Uro-gynecology Partnerships with Jewett Orthopaedic Clinic & Orlando Heart Institute Developing Outpatient Center in Lake Nona including ASC, Urgent Care, Imaging Center and Physician Offices 84 bed hospital formerly part of the Orlando Regional Health System Health Management acquired 80% majority interest in 2006 Current Projects under development: Build New 24 Bed ED and Cardiac Cath Lab 35
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Case Study: Wuesthoff Health System – Rockledge & Melbourne, FL
Vertical Integration Assisted Living Centers Nursing Homes Skilled Nursing Facilities Home Care Hospice & Palliative Care Acute Care Surgery and Imaging Centers Home Medical Equipment Regional Reference Lab Physician Relationships Focus on “splitter” physicians 83 employed physicians Recruited Osler Medical Group 47 multi-specialty physicians Wuesthoff Health System – Rockledge Wuesthoff Rockledge Melbourne Total Beds 298 115 413 FTEs 1,850 750 2,600 Discharges 12,830 5,320 18,150 Births 600 420 1,020 Surgeries 7,690 5,470 13,160 ER Visits 35,650 21,075 56,725 Net Revenue $226M $92M $318M Fiscal Year 2011
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