1. I.R.C.C.S. ISTITUTO ORTOPEDICO GALEAZZI ISOC 2010

2. ELENA BOTTINELLI ISOC 2010 Ceo of Istituto Ortopedico Galeazzi since 2005 Biomedical engineer Past experience in orthopaedics companies (Smith+Nephew, Zimmer) Working in Istitututo Ortopedico Galeazzi since 2000

3. ISOC 2010 ITALIAN HEALTHCARE SYSTEM “BEVERIDGE” UNIVERSALITY AND SOLIDARITY REGIONALISED REGIONS ARE PAYERS AND RULERS DRG SYSTEM (ICD9CM24: LUM:primary:8.695 revision:8.789, E.R:9.357 revision: 17.712, tuc:9.070) LUMBARDY FREE CHOICE: COMPETITION

4. Founded in 1961, has been for years a clear choice for any kind of muskuloskeletal pathologies. In May 2000 the hospital has joined Gruppo Ospedaliero San Donato, the largest Italian private owned health group (760mil€, 6.600 hip and knee replacements). In 2006 it has become centre of research in muskuloskeletal pathologies for Italian Health Ministry (IRCCS). ISOC 2010 IRCCS ISTITUTO ORTOPEDICO GALEAZZI

5. 934 employees 242 MDs (80 ortho) 357 beds: Musculoskeletal area: 166 orthopaedic surgery 15 neurosurgery 128 rehabilitation 5 rheumatology 8 intensive care Ancillary area: 15 vascular surgery 10 plastic and reconstructive surgery 10 maxillofacial surgery ISOC 2010 IRCCS ISTITUTO ORTOPEDICO GALEAZZI

6. Excellence in clinics: First orthopaedic institute in Lumbardy since 2000 Education:Teaching hospital (University of Milan) since 2002 and site of Bioengeneering practice Politecnico di Milano (Technical school) Research:IRCCS (research hospital of the italian health ministry) since april 2006 ISOC 2010 IRCCS ISTITUTO ORTOPEDICO GALEAZZI

7. 16.550 SSN HOSPITALIZATIONS in 2009 ISOC 2010 Lumbardy 71% Others italian regions 28% Foreign Countries 1% 12.024 ORTHOPAEDIC HOSPITALIZATIONS 11.021 SURGICAL (1942 hips and knees replacements 819 spine surgeries) 2.085 EMERGENCY HOSPIT.

8. SUPPLIES - 11 operating theaters (9 ORTHO): 1 Digital O.R., 1 O.R. with OARM (intraop. CT scan), all with PACS technology - Radiology, Image analysis dept: 3 MRI, 1 dedicated MRI (20.000 ex), 1 CT scan, 1 angiography, 1 MOC, 5 traditional RX systems, 2 orthopantomographies and 5 ultrasound systems, PACS/RIS technology. - 3 rehabilitation rooms supplied with isokinetic instruments, lasertherapy, gait analysis and lokomat system (robot-assisted treadmill), shock wave. - Research laboratories of Molecolar genetic, Molecolar Biology, Immunoreumathology, Bioimages, Biological structure Mechanic, Gait Analysis, Prosthesis surgery, Cellular Colture, Prosthesic Ortopaedic Register of Lumbardy (ROLP),. ISOC 2010

9. Joint replacement unit Sports medicine and arthroscopy surgery unit Knee unit Foot and ankle unit Hip unit Surgical arthritis unit Hand and elbow unit Shoulder unit Spine and scoliosis unit Pediatric orthopaedic surgery unit Orthopaedic Trauma unit Ortopaedic infection unit Bone tumor unit ORTHOPAEDIC SURGERY: ISOC 2010

10. ORTHOPAEDICS HOSPITALIZATION (ORDINARY ) IN LUMBARDY – 2003-2008 Source: Data bank of Lumbardy, D.M. 23/12/96 ISOC 2010

11. UNIVERSITY: ISOC 2010 RESEARCH (400 I.F.): Statistics in orthopaedics and registry- - 8 projects Bioengineer and tissue engineer- 16 projects Imaging- 23 projects Orthopaedic surgery- 18 projects Rehabilitation- 11 projects Spine- 9 projects University teachings (medical school) Orthopedic fellowships (15) Stages International and national meetings Trainings Professional education On site cme programs

12. PROFIT FOLLOW THE RULES OF THE REGION: “accreditamento” (org/struct) Growth limit for regional patients drg Inpatients/outpatients Physician contracts Use of beds CHALLENGES: (PRIVATE OWNED HOSPITAL): ISOC 2010 benchmarks (measure, compare) Flexibility (organization, assets)