1. NH Society of Healthcare Engineers and Vermont Healthcare Engineers Society Twin State Seminar July 28, 2011

2. Welcome to DHMC and the Third Annual Twin State Seminar

3. Some Perspective on the Challenges Facing Our Nation and Our Industry But First…a Test

4. 2000 to 2010 Growth - DHMC Discharges 35% - DHMC OR Cases 60% 34 Years 10 Years 5 Years

5. 2000 to 2010 Growth - DHMC Discharges 35% - DHMC OR Cases 60% 34 Years 10 Years 5 Years When Does the Aging of America Begin?

6. 2000 to 2010 Growth - DHMC Discharges 35% - DHMC OR Cases 60% 34 Years 10 Years 5 Years 5 Years

7. The Medicare population as a % of the U.S. population will increase by approximately the same amount over the next 10 years as it has since inception. 45% of that increase will occur in the next five years. Access will be a challenge even without reform Facility Requirements Will Be Significant

8. Per capital health care spending for the 65 and older population is more than five times higher than spending per child and three times spending per working-age person

9. - U.S. Health Care Expenditures We are on a pathway as a nation that is unsustainable

10. Health Care Reform Oversimplified At the highest level, the health care system in the U.S. is too costly and doesn’t produce outcomes commensurate with the investment we are making (currently 16% of GDP) Health care reform in its most simplistic form is about impacting cost and quality/outcome and creating value As health care providers we need to be laser focused on: This focus is very consistent with the fundamentals of health care reform and is what society is expecting of us. Value = Quality Time Cost

11. Takeaway Combining the rapid change which will occur in the Medicare population with the fact that the majority of the health care dollar is spent in the latter years of life will put significant pressure on the U.S. health care system and capacity (beginning in the next five years) 11 As Facilities Managers and Engineers you will need to be at the top of your game: - Access - Quality - Cost - Contributing to the financial sustainability of your organizations

12. The Impact of Engineering and Facilities Management on DHMC

13. We Have a Rich History Dartmouth-Hitchcock Clinic Founded 1927 (over 80 years ago) Mary Hitchcock Memorial Hospital, founded 1893 (almost 120 years ago)

14. We’ve Come A Long Way ( DHMC 20 Years Ago)

15. Who We Are Today Has Been Largely Influenced by Our Facility

16. Where Will We Be in 2030? ?

17. Project Description: – 102,750 Square Feet – $38 million project including equipment Strategic Investment: – Facilitating project to provide Inpatient capacity (at a controlled cost) – Outpatient capacity (50,000 sq. ft. for Medical Homes) – Flexible and Cost Effective Ramifications if not built: – Capped inpatient capacity – Family Medicine stays in adequate space – Constrained outpatient volume – Loss of current investment D-H Heater Road

18. Project Description: – Two ORs, Intra-Op MRI and CT – 12,000 Square Feet, – Total Project cost: $19.4 million – D-H Share: $6.2 million with balance from NIH and Dartmouth College Strategic Investment: – Only research facility of its type in the country. – Design of new integrated imaging and surgical systems (only intra-op in the country with both MRI and CT) – Excellent opportunity to improve outcomes/reduce cost nationally – Key differentiating service Ramifications if not built: – Loss of NIH grant funding ($10 million) – Missed opportunity for advanced imaging excellence Advanced Surgery Center for Translational Research

19. Mission Vision We advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time. Achieve the healthiest population possible, leading the transformation of health care in our region and setting the standard for our nation.

20. Mission Vision We advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time. Achieve the healthiest population possible, leading the transformation of health care in our region and setting the standard for our nation. People

21. Thank You for Coming and Thank You for All That You Do for the Patients and Staff of the Organizations You Support and Care For!