Phoenix Service Unit / Phoenix Indian Medical Center

1. Phoenix Service Unit / Phoenix Indian Medical Center Program Justification Document (PJD) Update November 2003

2. Master Plan - Vision Master Plan Results Master Plan Implementation PHOENIX AREA INDIAN HEALTH SERVICESINTEGRATED SERVICE DELIVERY NETWORK (ISDN)AREA WIDE MASTER PLAN Primary Service Areas Regional Service Areas Area-Wide Service UTAH PITU - CDBG NEVADA Walker River– FEMA/PJD Reno-Sparks – SAP Las Vegas – SAP/CDBG ARIZONA Ft. Mohave – CDBG Peach Springs – CDBG Phoenix – PJD San Carlos – PJD Supai - PSD Whiteriver – PJD Yuma – PJD Parker VISITING PROFESSIONALS Increased Specialty Care Visits TELEHEALTH Teleradiology Telemedicine Video Conference TRANSPORTATION MULTI-FACILITY INTEGRATION EPIDEMIOLOGY “Provide levels of care which value patient treatment as close to their homes and families as possible, but which provides for the highest quality referral services and inpatient treatment as necessary to ensure the best treatment available.” ARIZONA Ft. Yuma Ft. Mohave Parker Chemehuevi Payson Middle Verde Prescott Phoenix San Lucy Salt River Ft. McDowell Ak-Chin Hu-Hu-Kam West End Bylas San Carlos Cibecue Whiteriver Hopi Peach Springs Supai NEVADA Las Vegas Moapa Yerington Reno-Sparks Washoe Pyramid Lake Fallon Walker River McDermitt Winnemucca UTAH Goshute Skull valley Salt Lake City Ft. Duchesne PITU Kaibab NEVADA Southern Nevada Northwest Nevada Central Nevada Northeast Nevada UTAH Northwest Utah Northeast Utah Southwest Utah ARIZONA Colorado River System Phoenix San Carlos Whiteriver Northern Arizona Phoenix Area Health Care System Replacement Facility Central Campus “We envision a “Compre-hensive Regional Health Care System” which is built upon the success and ability of each local health care delivery area within the Phoenix Area, to access a full range of health care services and facilities in the fairest, most equitable and cost-effective manner possible.” Health Station Health Center Ambulatory Care Center Inpatient Hospital Inpatient Services Specialty Service Visiting Professionals Telemedicine Visiting Professionals Specialty Service Telemedicine Inpatient Service Specialty Care Integration: Access to care geographically & operationally, Integrated information systems, Multi-facility integration, Standards of care (clinical practice guidelines), Comprehensive services, Care coordination, Case management, Continuity of care, and Transportation

4. Master Plan Implementation • Master Plan - Vision Master Plan Results Primary Service Area Regional Service Area Area-Wide Service PRIMARY SERVICE AREA Southwest Southeast Northeast Central Phoenix - Ambulatory Care REGIONAL & AREA-WIDE SERVICE Central Phoenix – Inpatient Visiting Professionals Telehealth Inpatient Psych NATIONAL INSTITUTES OF HEALTH (NIH) “Provide levels of care which value patient treatment as close to their homes and families as possible, but which provides for the highest quality referral services and inpatient treatment as necessary to ensure the best treatment available.” Payson Middle Verde Prescott San Lucy Salt River Northeast Ft. McDowell Central Phoenix Southwest Southeast Hu-Hu-Kam West End Ak-Chin San Carlos Phoenix NEVADA - PSA - Region UTAH - PSA - Region ARIZONA - PSA - Region Health Station Health Center Ambulatory Care Center Inpatient Service Specialty Service Inpatient Service Specialty Service Visiting Professionals Telemedicine Inpatient Service Specialty Service Visiting Professionals Telemedicine We envision a “Compre-hensive Regional Health Care System” which is built upon the success and ability of each local health care delivery area within the Phoenix Area, to access a full range of health care services and facilities in the fairest, most equitable and cost-effective manner possible. PHOENIX INDIAN MEDICAL CENTER HEALTH CARE REPLACEMENT FACILITY

6. Planning for a PIMC Healthcare System Replacement • PIMC is on the IHS Facilities Priority List for a replacement hospital • Due to the size of this project, a “healthcare system” is being planned • Work started on the Program Justification Document (PJD) in June 2002, to begin to look at “options” for the satellites • Following completion & acceptance of the Area-wide Master Plan in Nov. 2002, we were able to begin planning for the Medical Center/Hospital Services

7. Planning for a New PIMC H.C. System Options proposed: • Three Satellite Ambulatory Care Centers: • Northeast (NE) • Salt River Pima-Maricopa Indian Community • Southeast (SE) • Gila River Indian Community • Southwest (SW) • Gila River Indian Community • Central Phoenix (16th Street) • Ambulatory Care • Inpatient Care • NIH

8. Existing Phoenix Indian Medical Center Campus-Indian School/16th Street Proposed Northeast Ambulatory Care Center-Indian School/Pima Road Proposed Southwest Ambulatory Care Center- 51st Ave/Pecos Road Proposed Southeast Ambulatory Care Center - Queen Creek/Old Price Road

9. Southwest Ambulatory Care Clinic • Location: 51st Avenue & Pecos Road • Site approved by Tribal Resolution, Sept. 3, 2003 by the Gila River Indian Community • 2015 Population Projection: 5,707 Users • 2015 Projected Workload: 49,050 OPV’s • Size: 62,734 Sq. Feet (5,828 Sq. Meters) • Space: 25 Exam Rooms; includes 8 PC, 3 Spec. Care, 4 VP, and 10 BH • Space: 15 Dental Chairs • Staffing: 128.4 FTE’s

10. Clinical Services Family Practice Internal Medicine Pediatrics OB/GYN Dental Optometry Podiatry Audiology Behavioral Health Visiting Professionals Orthopedics Ophthalmology General Surgery Otolaryngology Cardiology Urology Neurology Traditional Healing Southwest Ambulatory Care Clinic – Clinical Services

11. Ancillary Services Clinical Lab Pharmacy Radiology Ultrasound Mammography Physical Therapy Case Management TeleHealth Preventive Care Public Health Nursing Public Health Nutrition Environmental Health Health Education Southwest Ambulatory Care Clinic –Other Services

12. Admin. Support Administration Information Management Health Information Management Business Office Facility Support Clinical Engineering Facility Management Property/Supply Housekeeping Southwest Ambulatory Care Clinic –Other Services

13. Southeast Valley Ambulatory Care Clinic • Location: Queen Creek & Old Price Road • Site approved by Tribal Resolution, Sept. 3, 2003 by the Gila River Indian Community • 2015 Population Projection: 14,453 Users • 2015 Projected Workload: 117,002 OPV’s • Size: 121,765 Sq. Feet (11,312 Sq. Meters) • Space: 49 Exam Rooms (include 24 PC, 3 Spec. Care, 5 VP, and 17 BH) • Space: 30 Dental Chairs • Staffing: 273.3 FTEs

14. Clinical Services Family Practice Internal Medicine Pediatrics OB/GYN Dental Optometry Podiatry Audiology Behavioral Health Urgent Care Visiting Professionals Orthopedics Ophthalmology General Surgery Otolaryngology Cardiology Urology Neurology Traditional Healing Respiratory Therapy Southeast Ambulatory Care Clinic – Clinical Services

15. Ancillary Services Clinical Lab Pharmacy Radiology Ultrasound Mammography Physical Therapy Case Management TeleHealth Preventive Care Public Health Nursing Public Health Nutrition Environmental Health Health Education Southeast Ambulatory Care Clinic –Other Services

16. Facility Support Clinical Engineering Facility Management Property/Supply Housekeeping Security Transportation Telephone Operators Southeast Ambulatory Care Clinic –Other Services • Admin. Support • Administration • Information Management • Health Information Management • Business Office • CHS • Performance Improvement

17. Northeast Ambulatory Care Clinic • Location: Indian School & Pima Road • Site approved by Tribal Resolution, Sept. 3, 2003 by the SRPMIC Tribal Council; • Maintain Community Clinic • Study the Hospital at later date • 2015 Population Projection: 15,305 Users • 2015 Population Workload: 124,837 OPVs • Size: 132,067 Sq. Feet (12,269 Sq. Meters) • Space: 57 Exam Rooms (includes 26 PC, 3 Spec. Care, 5 VP, and 23 BH) • 30 Dental Chairs • Staffing: 285.5 FTEs

18. Clinical Services Family Practice Internal Medicine Pediatrics OB/GYN Dental Optometry Podiatry Audiology Behavioral Health Urgent Care Visiting Professionals Orthopedics Ophthalmology General Surgery Otolaryngology Cardiology Urology Neurology Traditional Healing Respiratory Therapy Northeast Ambulatory Care Clinic – Clinical Services

19. Ancillary Services Clinical Lab Pharmacy Radiology Ultrasound Mammography Physical Therapy Case Management Telemedicine Preventive Care Public Health Nursing Public Health Nutrition Environmental Health Health Education Northeast Ambulatory Care Clinic –Other Services

20. Facility Support Clinical Engineering Facility Management Property/Supply Housekeeping Security Transportation Telephone Operators Northeast Ambulatory Care Clinic –Other Services • Admin. Support • Administration • Information Management • Health Information Management • Business Office • CHS • Performance Improvement

21. PIMC Central – Ambulatory Care • Location: 16th Street & Indian School Road • 2015 Population Projection: 47,608 Users • 2015 Projected Workload: 317,828 OPVs • Size: 378,235 Sq. Feet (35,138 Sq. Meters) • Space: 170 Exam Rooms (includes 24 PC, 48 Spec. Care, 1 VP Clinic, 79 BH and 18 ED patient spaces), 80 Dental Chairs • Staffing: 1,690.7 FTEs (outpt. & inpt.)

22. PIMC Central – Inpatient Care • Location: 16th Street & Indian School Road • 2015 Population Projection: 47,608 Users • 2015 Projected Workload: 40,307 Patient Days • Size: 299,440 Sq. Feet (27,818 Sq. Meters) • Combined with Outpatient – 677,675 Sq. Feet (62,956 Sq. Meters) • Beds: 140 • OR’s: 7

23. PIMC Central – Inpatient Care • TOTAL BEDS: 140 • MEDICAL: 40 • SURGERY/PEDIATRICS: 30 • ICU: 18 (12 ICU/6 Step-down) • OB/LDR: 19 • PSYCHIATRIC: 11 • NIH RESEARCH: 22

24. Clinical Services: Primary Care & Other Ambulatory Care • Family Practice • Internal Medicine • Pediatrics • OB/GYN • Dental • Optometry • Audiology • Emergency Medicine

25. Anesthesia/Pain Medicine Orthopedics Ophthalmology Dermatology General Surgery Otolaryngology Cardiology Urology Neurology Nephrology Allergy Pulmonology Gerontology Gastroenterology Rheumatology Oncology Podiatry Behavioral Health Endocrinology Infectious Disease Clinical Services – Specialty Care

26. Nuclear Medicine CT MRI TeleHealth Occupational Therapy Speech Therapy Sleep Lab Hostel – boarding rooms Transport team Acute Dialysis Clinical Services – Other New Services

27. NIH/NIDDK • Location: 16th Street & Indian School Road • Size: 128,999 Sq. Feet (11,984 Sq. Meters) • Beds: 22 • Space: Clinical Lab, Biochemistry Lab, OP Clinic, Nursing Unit, Medical Library, Conf. Rooms, Offices, etc.

28. Proposed Central Campus with three outlying Ambulatory Care Centers Northeast Ambulatory Care Center 12,269 m2 - $39 Million • Outpatient Tower & Parking Structure • 35,138 m2 - $128 Million • Inpatient Tower & Parking Structure 27,818 m2 - $193 Million • NIH/NIDDK Research Facilities • 11,984 m2 - $65 Million Southwest Ambulatory Care Center 5,828 m2 - $17 Million Southeast Ambulatory Care Center 11,312 m2 - $34 Million • Total Estimated Project Cost $476 Million • Total Proposed Space = 104,349 m2 • Phased Construction over 10 years - Starting w/ Ambulatory Care Centers • $6.6M for Design in FY05 IHS Budget Request

29. Ambulatory Care A/E Selection Jan. ‘05 – May ‘05 Design May ’05 – May ’06 Bidding May –06 - Aug. ’06 Construction Aug. ’06 – Oct. ‘07 Hospital A/E Selection Sept. ’07 –May ’08 Design May ’08 – Nov. ’10 Bidding Nov. ’10 – Feb. ’11 Construction Feb. ’11 – Feb. ‘16 Construction Timeline

30. Planning for a New PIMC H.C. System • The planning document (PJD) was submitted to HQE on September 12, 2003 • PJD is currently in review for approval with HQE • IHS needs to request $6.6 million for design funding in the FY 2005/6 Budget • NIH/IHS need to discuss strategies for funding and congressional support at the Agency level