1. Healtheast Emergency Medicine Practice State of the Practice

2. Healtheast Emergency Medicine Healtheast Vision o "Building on our benchmark performance, HealthEast will be a national leader in clinical quality, patient experience and cost effectiveness – the best value – by 2015.” Emergency Medicine Practice o Best Practice Emergency Medicine Clinical quality Patient Experience o Practice of choice for area EM Providers o Financially Responsible Practice 3 Departments 93,000 pts 35 MD’s 7 PA’s 2 NP’s

3. Department Demographics Johns o 40,000 pts o 27% Admissions o 74% of inpt admissions from ED o LOS 230 min Joes o 24,000 pts o 31% Admissions o 60% of inpt admissions from ED o LOS 255 min WW’s o 29,000 pts o 16% Admissions o 59% of inpt admissions from ED o LOS 171 min

4. Practice Demographics 0-5  10 MD’s o Ashley Seivers o Dan Thomas o Eric Roth o Jeremy Joy o Alex Gerbig o Shani Go o Cindy Winebrenner o Dana Stephens o Jocelyn Wong o Jennifer Englund 6-10  10 MD’s o Maryam Shapland o Scott Nichols o Tony Nardi o Verna Arcedo o Kai Tuominen o Nancy Blonigen o Kurt Keogh o Deb Lidahl o Kearney Stakes o Pete Tanghe > 10  14 MD’s o Brian Ness o Grant Nakamura o John Flipovich o Paul Sovell o Paul McCormick o Ed Feinstein o Mark Newman o Bob Kile o Sam Rice o Tim Thompson o Dan Berndt o Brad Barth o Jon Grimes o Al Autrey o Gerald Hill

5. Practice Demographics Joes Mark Newman Bob Kile Sam Rice Nancy Blonigen Tim Thompson Dan Berndt Brad Barth Brian Ness Verna Arcedo Al Autrey Gerald Hill WW’s Ashley Seivers Cindy Winebrenner Kurt Keogh Deb Lidahl Jocelyn Wong Maryam Shapland Scott Nichols Jon Grimes Matt Beatty Dan Spielman Johns Kearney Stakes Jennifer Englund Pete Tanghe Dana Stephens Dan Thomas John Flipovich Kai Tuominen Paul Sovell Jeremy Joy Paul McCormick Alex Gerbig Ed Feinstein Eric Roth Shani Go Mike Meyers Jen Kipp Deena G Jason Dukes

6. Financials Johns o MD FTE  9.11 o Mid FTE  3.88 o Total FTE  12.9 o Expenses  6,156,221 o Pro-fee Revenue  5,790,016 Joes o MD FTE  6.81 o Expenses  4,122,049 o Pro-fee Revenue  3,653,722 WW’s o MD FTE  6.2 o Mid FTE  1.91 o Total FTE  8.1 o Expenses  4,099,871 o Pro-fee Revenue  4,072,163

7. Clinical Measures Malpractice Claims o 8 “claims” in the last 3 years o 1 Indemnity paid (HIPPAA issue) Core Measures (clinical process) o 2012 3/7 at 90 th percentile o PCI in 90 min, blood cultures, abx choice HCAHPS (pt experience) o Pain mgmt, MD Communication, overall o 1/9 at 90 th percentile VBP (combine Core Measures and HCAHPS) o 1% withhold of Medicare dollars o EDCAPS coming 2014

8. Where were we?

9. Lots of Change Amion Dedicated Scheduler Coding Education Scribes Productivity Payments McKesson Telestroke, OFI’s Nighthawk Differential Studor initiatives QIP changes Robust, EM only Peer Review ED Clinical Council Email communication

10. Progress at what expense? Frustration Defections Disengagement

11. Our Vision Vibrant, stable Emergency Medicine Practice which contributes positively to Healtheasts mission Engaged (Satisfied) physicians and MLP’s with wide variety of backgrounds and experience level Group of provider partners who are interested in and see value in: o Best Practice Clinical Excellence Patient Experience Efficient Flow o Positive participation in group initiatives AND o Perceive themselves as leaders in department o Maintain Collaboration with departmental staff

12. What is providers role? Captain of Ship? One of the team “Just a trench doc” Emergency Medicine Physician “Nurses run the department” “You guys” make the decisions, I just follow orders Shift worker Partner Employee Independent Contractor

13. What do you want from a practice? Input? Improvement? “Just see patients” Participate? Grand Rounds Education Career development Stability More money