1. 1 Russ Ranallo, Vice President Financial Services

2. CON Listening Session Comments March 17, 2015 2

3. Certificate of Need (CON)  Does more than control Medicaid costs  Protects employers, patients and communities  Real world example of what will happen if CON is dismantled or changed without careful consideration of the consequences 3

4. Ambulatory Surgery  Owensboro, Kentucky  Hospital Operating Rooms – 7,000 cases  Free Standing ASC – 6 ORs- 3,800 cases  Gastro Only Center- 2 ORs – 2,600 cases  Rockport, Indiana  No certificate of need  Riverview Surgery Center- 3 Room ASC established 10 miles away from Owensboro in August 2012 4

5. Riverview Surgery Center  3,000 cases moved from region (Indiana State Dept. of Health Utilization Report)  Physician Owners Influence on Referrals  Out of Network Strategy  High Charge Levels  Claims Experience  Financial Impact to Employers and Community estimated at $10-15 Million per year. 5

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7. Employers Response  “Riverview Surgery Center is not a good deal at all for the employer or the employee.” - HR Director for a mid size Owensboro Employer Employer Learning Curve In-network vs. Out-of-Network deductible Employee not informed before surgery Lack of employee choice Advised employees to avoid Riverview 7