1. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando Mark R. Milunski, MD, FACC Florida Heart Group, PA Associate Professor of Medicine University of Central Florida College of Medicine Seminole County Medical Society September 16, 2008 Mark R. Milunski, MD, FACC Florida Heart Group, PA Associate Professor of Medicine University of Central Florida College of Medicine Seminole County Medical Society September 16, 2008

2. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando Why do we need one? Why do we need one? What’s involved? What’s involved? Will it succeed? Will it succeed? Why do we need one? Why do we need one? What’s involved? What’s involved? Will it succeed? Will it succeed?

4. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando Florida Adult Heart Transplantation Program Utilization January 2007- December 2007 Hospital OTSA District Total Procedures Shands Hospital at U of F 1332 Mayo Clinic 1422 Tampa General 2651 Jackson Memorial 41122 TOTAL127 OTSA - Organ Transplant Service Area Source: AHCA Utilization Data for Pediatric and Adult Organ Transplantation Programs published April 4, 2008

5. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando Adult Heart Transplantations Performed January 2003-December 2007 Facility Jan ‘03 Dec ‘03 Jan ‘04 Dec ‘04 Jan ‘05 Dec ‘05 Jan ‘06 Dec ‘06 Jan ‘07 Dec ‘07 TOTAL Shands Hospital at UF 2931332932154 Mayo Clinic 9127152265 Tampa General Hospital 5543615951269 Jackson Memorial Hospital 1831202822119 TOTAL111117121131127607 Source: AHCA Adult Organ Transplantation Program Utilization January 2003-December 2007

6. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando About 30-40 people are referred for heart transplant evaluation out of District 3 every year About 30-40 people are referred for heart transplant evaluation out of District 3 every year Nearest centers are 85-112 miles away Nearest centers are 85-112 miles away District 3 is the only region in the state with a major population center that doesn’t have a heart transplant program District 3 is the only region in the state with a major population center that doesn’t have a heart transplant program About 30-40 people are referred for heart transplant evaluation out of District 3 every year About 30-40 people are referred for heart transplant evaluation out of District 3 every year Nearest centers are 85-112 miles away Nearest centers are 85-112 miles away District 3 is the only region in the state with a major population center that doesn’t have a heart transplant program District 3 is the only region in the state with a major population center that doesn’t have a heart transplant program Why do we need one?

7. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando Infrastructure Infrastructure Bricks and mortar Bricks and mortar $255 million Ginsburg Tower $255 million Ginsburg Tower ED area - 62,000 sq ft with 50 exam rooms ED area - 62,000 sq ft with 50 exam rooms Cardiovascular Institute - 80,000 sq ft Cardiovascular Institute - 80,000 sq ft 12 cath lab/OR’s with shell space for 3 more labs 12 cath lab/OR’s with shell space for 3 more labs 14 pre-cath beds and 59 post-cath recovery beds 14 pre-cath beds and 59 post-cath recovery beds Reinforced floor for cardiac MRI Reinforced floor for cardiac MRI Full-service outpatient cardiovascular testing Full-service outpatient cardiovascular testing Dedicated unit for pre- and post-transplant patients Dedicated unit for pre- and post-transplant patients Infrastructure Infrastructure Bricks and mortar Bricks and mortar $255 million Ginsburg Tower $255 million Ginsburg Tower ED area - 62,000 sq ft with 50 exam rooms ED area - 62,000 sq ft with 50 exam rooms Cardiovascular Institute - 80,000 sq ft Cardiovascular Institute - 80,000 sq ft 12 cath lab/OR’s with shell space for 3 more labs 12 cath lab/OR’s with shell space for 3 more labs 14 pre-cath beds and 59 post-cath recovery beds 14 pre-cath beds and 59 post-cath recovery beds Reinforced floor for cardiac MRI Reinforced floor for cardiac MRI Full-service outpatient cardiovascular testing Full-service outpatient cardiovascular testing Dedicated unit for pre- and post-transplant patients Dedicated unit for pre- and post-transplant patients What’s involved?

8. Ginsburg Tower at Florida Hospital Orlando 15 stories 15 stories Each floor the size of a football field Each floor the size of a football field 440 new patient beds 440 new patient beds Will open on November 20, 2008 Will open on November 20, 2008 First cardiac catheterization planned for December 12, 2008 First cardiac catheterization planned for December 12, 2008 15 stories 15 stories Each floor the size of a football field Each floor the size of a football field 440 new patient beds 440 new patient beds Will open on November 20, 2008 Will open on November 20, 2008 First cardiac catheterization planned for December 12, 2008 First cardiac catheterization planned for December 12, 2008

9. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando Solid organ transplantation expertise Solid organ transplantation expertise 35 years of experience 35 years of experience Kidney, bone marrow, pancreas, liver Kidney, bone marrow, pancreas, liver On-site tissue typing laboratory On-site tissue typing laboratory Pathology expertise Pathology expertise Cardiothoracic transplants are a natural extension of both the cardiovascular and transplant programs Cardiothoracic transplants are a natural extension of both the cardiovascular and transplant programs Solid organ transplantation expertise Solid organ transplantation expertise 35 years of experience 35 years of experience Kidney, bone marrow, pancreas, liver Kidney, bone marrow, pancreas, liver On-site tissue typing laboratory On-site tissue typing laboratory Pathology expertise Pathology expertise Cardiothoracic transplants are a natural extension of both the cardiovascular and transplant programs Cardiothoracic transplants are a natural extension of both the cardiovascular and transplant programs What’s involved?

10. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando Experience Experience Busiest cardiovascular program in the U.S. Busiest cardiovascular program in the U.S. Over 82,000 cardiac surgical procedures over the last 40 years with <2% mortality Over 82,000 cardiac surgical procedures over the last 40 years with <2% mortality One year period ending 12/31/07 One year period ending 12/31/07 6,630 cardiac catheterizations 6,630 cardiac catheterizations 1,488 cardiac surgical procedures 1,488 cardiac surgical procedures Second busiest thoracic program in the U.S. Second busiest thoracic program in the U.S. Experience Experience Busiest cardiovascular program in the U.S. Busiest cardiovascular program in the U.S. Over 82,000 cardiac surgical procedures over the last 40 years with <2% mortality Over 82,000 cardiac surgical procedures over the last 40 years with <2% mortality One year period ending 12/31/07 One year period ending 12/31/07 6,630 cardiac catheterizations 6,630 cardiac catheterizations 1,488 cardiac surgical procedures 1,488 cardiac surgical procedures Second busiest thoracic program in the U.S. Second busiest thoracic program in the U.S. What’s involved? 2006 MedPAR data

11. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando Experience Experience Tissue typing facilities already well-established Tissue typing facilities already well-established Established outpatient Heart Failure Clinic Established outpatient Heart Failure Clinic Multiple qualified medical and surgical subspecialists are already in place Multiple qualified medical and surgical subspecialists are already in place Psychological and social services personnel already attuned to the transplant patient Psychological and social services personnel already attuned to the transplant patient Recruitment of 2 UNOS certified transplant cardiologists and pulmonologists and 2 surgeons Recruitment of 2 UNOS certified transplant cardiologists and pulmonologists and 2 surgeons Experience Experience Tissue typing facilities already well-established Tissue typing facilities already well-established Established outpatient Heart Failure Clinic Established outpatient Heart Failure Clinic Multiple qualified medical and surgical subspecialists are already in place Multiple qualified medical and surgical subspecialists are already in place Psychological and social services personnel already attuned to the transplant patient Psychological and social services personnel already attuned to the transplant patient Recruitment of 2 UNOS certified transplant cardiologists and pulmonologists and 2 surgeons Recruitment of 2 UNOS certified transplant cardiologists and pulmonologists and 2 surgeons What’s involved?

12. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando Relationships Relationships Long-established cardiovascular research program - Florida Heart Institute Long-established cardiovascular research program - Florida Heart Institute Affiliations with: Affiliations with: Emory University Emory University Loma Linda University Loma Linda University University of Central Florida College of Medicine University of Central Florida College of Medicine Burnham Medical Research Institute Burnham Medical Research Institute Relationships Relationships Long-established cardiovascular research program - Florida Heart Institute Long-established cardiovascular research program - Florida Heart Institute Affiliations with: Affiliations with: Emory University Emory University Loma Linda University Loma Linda University University of Central Florida College of Medicine University of Central Florida College of Medicine Burnham Medical Research Institute Burnham Medical Research Institute What’s involved?

13. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando Implementation Implementation First heart transplant planned to take place before July 1, 2009 First heart transplant planned to take place before July 1, 2009 12 transplants planned for the first year 12 transplants planned for the first year 18 transplants planned for the second year 18 transplants planned for the second year A minimum of 10% of these will be Medicaid or charity cases A minimum of 10% of these will be Medicaid or charity cases 10 transplants will be provided to Medicare enrollees without charge while awaiting Medicare approval 10 transplants will be provided to Medicare enrollees without charge while awaiting Medicare approval Medicare approval after 10 transplants done Medicare approval after 10 transplants done Minimum volume of 10 transplants per year Minimum volume of 10 transplants per year Meet Medicare-specified patient survival standards Meet Medicare-specified patient survival standards Implementation Implementation First heart transplant planned to take place before July 1, 2009 First heart transplant planned to take place before July 1, 2009 12 transplants planned for the first year 12 transplants planned for the first year 18 transplants planned for the second year 18 transplants planned for the second year A minimum of 10% of these will be Medicaid or charity cases A minimum of 10% of these will be Medicaid or charity cases 10 transplants will be provided to Medicare enrollees without charge while awaiting Medicare approval 10 transplants will be provided to Medicare enrollees without charge while awaiting Medicare approval Medicare approval after 10 transplants done Medicare approval after 10 transplants done Minimum volume of 10 transplants per year Minimum volume of 10 transplants per year Meet Medicare-specified patient survival standards Meet Medicare-specified patient survival standards Will it succeed?

14. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando CON application approval - Florida Administrative Weekly CON application approval - Florida Administrative Weekly Florida Hospital Florida Hospital CON #10026 (Heart) CON #10026 (Heart) CON #10028 (Lung) CON #10028 (Lung) ORMC ORMC CON #10027 (Heart only) CON #10027 (Heart only) http://ahca.myflorida.com/MCHQ/CON_FA/Batching/pdf/10027.pdf http://ahca.myflorida.com/MCHQ/CON_FA/Batching/pdf/10028.pdf CON application approval - Florida Administrative Weekly CON application approval - Florida Administrative Weekly Florida Hospital Florida Hospital CON #10026 (Heart) CON #10026 (Heart) CON #10028 (Lung) CON #10028 (Lung) ORMC ORMC CON #10027 (Heart only) CON #10027 (Heart only) http://ahca.myflorida.com/MCHQ/CON_FA/Batching/pdf/10027.pdf http://ahca.myflorida.com/MCHQ/CON_FA/Batching/pdf/10028.pdf References

15. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando CMS CMS http://www.cms.hhs.gov/CertificationandComplianc/20_Transplant. asp http://www.cms.hhs.gov/CertificationandComplianc/20_Transplant. asp CMS CMS http://www.cms.hhs.gov/CertificationandComplianc/20_Transplant. asp http://www.cms.hhs.gov/CertificationandComplianc/20_Transplant. asp References

16. Heart and Lung Transplantation Program Florida Hospital Medical Center Orlando