1. Universal Service: What it means for Rural Hospitals Jason C. Wulf Financial Analyst Thursday, May 15, 2003, 3:45 to 5:00

2. About Avera Health Sponsored by the Presentation and Benedictine Sisters Located in 5 States, SD, ND, MN, IA, NE Hospitals in 26 communities Clinics in 59 communities Long-term care in 17 communities Home Medical Equipment businesses in 20 communities

4. Rocky start Streamlined and more user friendly after Funding Year 3 Online forms have greatly enhanced the process Help desk does exceptional job RHC willing to listen and make changes when necessary Experience with RHC

5. Rural telecommunication companies sometimes not familiar with RHC process or forms Big telecommunication companies shift paperwork responsibility around and things get lost in the shuffle

6. Benefits – Rural Community Telehealth –Educational sessions Freedom from smoking Diabetes club –Expanded services Specialists –Reduced travel for rural citizens

7. Benefits – Rural Hospital Expanded services and capabilities –Telehealth Education –Grand rounds, HIPAA Sessions, Mandatory In-services Telemedicine –Mental health, dermatology, pulmonology, internal medicine, fetal ultrasounds, infectious disease Teleradiology –Clinical and financial data systems –Internet –E-mail

8. Benefits – Rural Hospital The RHCD reimbursement makes the T1 line a little easier to afford for rural facilities. This in turn means when we were making decisions for the connections via email, information system, teleradiology, teleconferencing equipment, etc. to our regional hospital, it makes it more affordable. We get about $600 a month reimbursement from RHCD for our T1 line which means $7,200 annually which is quite a large amount for a small facility. Kayleen Lee – Administrator and Linda Jager – Business Office Manager, Avera Weskota Hospital, Wessington Springs, SD

9. Benefits – Health System Provide education and services to small hospitals –HIPAA sessions, Medicare A Newsline Review, unified information systems platforms Enhanced communication –Videoconferencing when Telehealth is not in use Administrative meetings –Negotiate better pricing on information technology projects due to large Wide-Area Network and interconnected systems

10. Benefits – Health System Significant savings –Year 1 - $ 128,819 –Year 2 - $ 64,327 –Year 3 - $ 244,534 –Year 4 - $ 279,639 estimated –Year 5 - $ 395,081 projected –Total - $1,112,400 Directly back to the hospitals Roughly 55% - 60% savings off gross charges/year Covers 44 locations and 55 circuits across Avera Health

11. RHCD help line 1-800-229-5476 www.rhc.universalservice.org Jason Wulf – Avera Health 605-322-4722