The Methodist Hospital Update: QUARTELY MEDICAL STAFF MEETING

1. MARC BOOM, M.D. • JUNE 15, 2010 • HOUSTON, TEXAS The Methodist Hospital Update:QUARTELY MEDICAL STAFF MEETING

2. Accolades • Dr. Laura Morrisonhas been selected as the winner of the AAMC Humanism in Medicine Award by the medical students and has been submitted as a candidate for the national award, which will be presented this fall. • Drs. Eugene Alford, Brian Butler and James Musser won the Houston Business Journal’sHealth Care Heroes Award in their respective categories.

3. Accolades • The Houston Surgical Society named • Dr. George Noon asthe 2010 Houston Distinguished Surgeon. • Dr. Alberto Ayalareceived the Koss Medal for career achievements in Urological Pathology.  This is the highest recognition by the urologic pathologists. 

4. Health Care Reform

5. Health Care Spending Two Key Failings of Our Health Care System Health Care Spending as Percentage of GDP OECD Health Data 2008. France: Organization for Economic Co-operation and Development and IRDES (Institute for Research and Information in Health Economics), 2008. (No authors given.) Robert Wood Johnson Foundation, June 2009.

6. Health Care Reform • Cost - $940 billion over 10 years • Medicaid and CHIP expansion • Insurance subsidies • Small employer tax cuts

7. Impact on Hospitals • Reduces Medicare payments by 0.1% • Reduces Medicare payment by 0.3% • Reduces Medicare payments by 0.2% 2010 2011 2012 2013 2014 2015 • RAC programs expanded to include audits • Reduces inpatient and outpatient hospital payment by 0.2% • Reduces Medicare payments by 0.1% • Reduces Medicare payments by 0.25%

8. The “Shrinking” Dollar

9. In fact, it’s already happening… Monday, April 19, 2010…. Proposed CMS rule decreases FY 2011 hospital payments by 0.1% • Expected cut to an inflationary update would amount to a $3.7 billion hit for our nation’s hospitals • CMS • Attempt to recoup payments from the industry for inaccurate coding practices

10. Our Economy

11. TMH Net Income 5% Margin

12. Volumes Patient Admission Month over month/ Year over Year Comparison 2000 - 2010

13. Realization Rate 2010 Realization Rate

14. Action Plan What are we doing about it? • 25 out of 241 cost centers over budget • Decrease overtime use to less than 3% • Improve efficiencies in labor and non-labor • Reduce average length of stay to top decile of UHC • Opportunity for physician growth • Align strategy throughout TMHS

15. How best can we work together? • Length of Stay • Efficiency/Utilization

16. 2010 ALOSMetrics UHC TMH AVERAGE LENGTH OF STAY INDICES (Total Inpatient Population; August 2009 UHC Risk Model) ** lower than UHC expected value, highly significant (p = < 0.01) Source: UHC Clinical Data Base, as of 6/2/2010

17. Length of Stay Activities:  Updates • Goal: Improve processes to insure appropriate patient throughput across continuum of care • Why all the effort?? • Improve safety • Enhance patients and family experience • Expedite patient discharge • Optimize hospital capacity • Eliminate unnecessary delays in treatment, testing • Reduce readmission rate

18. Length of Stay Activities: Updates Current Initiatives Underway • Collaborative effort with Department Chairs, Physician staff, and Executive team in identification of patient populations requiring focused efforts regarding throughput • Daily Multidisciplinary rounds with entire care team and Executives to identify individual patient plans of care and discharge needs • Implementation of weekend processes that assure patient transfer/discharge: on site case management, social work, operations administrators and NP’s • Improved utilization of community SNF,  LTAC networks and  Home Healthcare • Implementation of Admission Status Protocol:  July, 2010 •  Improve compliance with Medicare and Medicaid regulations • Appropriate status of patient given by case management on admission

19. 2010 Mortality Metrics UHC TMH MORTALITY INDICES (Total Inpatient Population; August 2009 UHC Risk Model) ** lower than UHC expected value, highly significant (p = < 0.01) Source: UHC Clinical Data Base, as of 6/2/2010

20. 2010 Readmission Metrics UHC TMH PERCENT 30-DAY RELATED READMISSIONS (Total Inpatient Population; August 2009 UHC Risk Model) “n” = Number of hospitals in compare group Source: UHC Clinical Data Base, as of 6/2/2010

21. LOS vs. Bed Availability

22. Radiology Utilization Trends • Inpatients having “the Methodist workup” for the convenience of the patient “since they are here, let’s get a xxx done” • For example: Patient being transferred back to Beaumont and is due for a biopsy there soon and attending has it done before they leave • Inpatient has diagnosis unrelated to cancer and something suspicious is found on a scan • Physician orders a whole diagnostic workup for the possible cancer while patient is still an inpatient • Multiple echoes, peripheral vascular studies, and chest x-rays being done during the same inpatient stay • Currently we are reviewing order sets for unnecessary labs, imaging, etc. • Reimbursed according to bundled payment or MS-DRG

23. The Methodist Hospital Research Institute

24. Research Institute • Thank you • A special thank you to Dr. Lieberman – retiring June 30, 2010 • TMHRI President and CEO Search Update • Search committee composed of clinical, scientific and executive leadership • Excellent local and national candidates • Chair of Pathology Search • Excellent local and national candidates

25. TMHRI Building Update The building is nearly complete; investigators and their staff will begin moving into office and lab space this summer. The 440,000 sq. ft. facility includes: • Cyclotron in the basement • State of the art auditorium and pre-function space on the second floor • MITIE facility on the fifth floor • Four lab floors (two shell) – enough space for 90 investigators • Inter-connective lounge between lab floors • A connecting corridor to The Methodist Hospital

26. TMHRI

27. Lobby

28. Auditorium

29. Other News

30. Residency Graduation • June 18th 7 p.m. • Crain Garden • 5th TMH Residency Graduation • 69 Graduates • First graduating class: • 5 graduates from the Internal Medicine program • 1 graduate from the OB/GYN program (entire program at TMH) • 1 graduate from the Breast Imaging program (non ACGME) • 1 graduate from the Minimally Invasive Gynecological program (non ACGME)

31. Residency Programs • 168 TMH residents • 23 ACGME-accredited Residency Programs • More than 200 residents from other medical schools • More than 300 physicians with Weill Cornell faculty appointments • Residents cover Pathology, Neurosurgery, OB/Gyn, General Surgery, Plastic Surgery, Family Medicine and more • Cardiovascular disease (2010)

32. New Fellowships • The Accreditation Council for Graduate Medical Education (ACGME) has accredited a fellowship in Molecular Genetic Pathology.  • This single fellow program will begin training on July 1, 2010 • The Program Director is Dr. Federico Monzon • The ACGME also has accredited the HLA (Pathology) Fellowship Program.  • This program has the distinction of being the first program of its kind in the United States and is paired with UT M. D. Anderson Cancer Center. • The Methodist program will train pathology physicians and M.D. Anderson will train PhD applicants to become HLA experts and laboratory directors.  • The program director is Dr. David Bernard and the Associate PD is Dr. Geoffrey Land. 

33. CPOE

34. NextGen E.H.R • Pre-built clinical templates and workflow for accurate, standardized documentation and access • Disease management templates capture discrete data at the point of care to meet clinical reporting guidelines for pay-for-performance programs • ePrescribing & Medication Management Module Benefits • Access patient records instantly – anytime, anywhere • Improve medication management protocols • Integrate scheduling and admissions tasks in one system • Improve financial, clinical and administrative reporting • Receive TMHS and national lab (Quest and LabCorp) results electronically, seamlessly linked to the patient record

35. TMHS Pricing 1Cost decreases with larger practices

36. Physician Opinion Survey 2010 Engagement Composite Questions: • I would recommend The Methodist Hospital to family and friends who need care. • Overall, The Methodist Hospital provides high-quality care and service. • The Methodist Hospital makes every effort to deliver safe, error-free care to patients. • Overall, I am satisfied working with The Methodist Hospital. • If I am practicing medicine three years from now, I am confident that I will be practicing at The Methodist Hospital.