The Ohio State University Medical Center

1. The Ohio State University Medical Center March 3, 2009 Ohio School Employees Health Care Conference

2. Ohio School Board Requirements Ohio school districts are required to provide access to providers that have demonstrated effectiveness based on objective measureable criteria in treating complex conditions such as: • Transplant • Cancer • Heart Disease • High Risk Pregnancy • Morbid Obesity

3. Columbus Hospitals Outperformed Ohio and National Average in ‘08 Source: U.S. Department of Health and Human Services on the “Hospital Compare” website (www.hospitalcompare.hhs.gov). Using Medicare quality indicators reported for participating adult hospitals analysis compares the average performance of OhioHealth, Mount Carmel, and OSU Hospitals to the national average on each indicator. The statistic reports on average how much these local hospitals exceed the national average on indicators within each category. 2008 Q2.

4. Employer Considerations What employers look for -- quality, cost, access: • Integrated health care system • Continuous improvement in delivery • Institutions delivering best practices • Physicians at forefront of clinical research • A multidisciplinary approach to disease prevention and disease management • Exclusive disease specific expertise

5. Alternative Measures • 16 consecutive years named one of “America's Best Hospitals” by US News & World Report • 8 of 11 specialties currently ranked in central Ohio as “America’s Best Hospitals,” U.S. News & World Report. • Cancer, ENT, Endocrinology, Gynecology, Kidney Disease, Orthopedics, Rehab, Respiratory Disease • 259 of 420 or 62% of central Ohio physicians listed in “America’s Best Doctors.” • 92% of physicians board-certified; compared to 85% nationally.

6. Centers of Excellence & JCAHO • Designated a Center of Excellence in Bariatric Surgery by the American Society of Bariatric and Metabolic Surgery • Joint Commission disease specific certification for • Stroke Care • Lung Volume Reduction Surgery • Ventricular Assist Devices

7. Integration of Research and Clinical Practice Clinical Question Quality Assessment Basic Bench Research Clinical Protocol Standard of Care Translational Application Development Clinical Research Protocol

8. Importance of Research • OSUMC houses or co-manages more than 20 research centers and institutes and 25 core research laboratories, plus one affiliated research core lab • Ranked 21st by National Science Foundation in medical sciences for FY 2006, up from 25th in FY 2005 • More than 2,000 active clinical trials in virtually every medical specialty

9. Mortality Rates and UHC Comparisons Risk adjusted mortality rates: • Less than other academic medical centers • Only 1 US News & World Report Honor Roll Hospital with a lower mortality index • Ranked 7th out of 100 Academic Medical Centers • Ranked in the top 25 in multiple disease groups compared to other academic medical centers • Includes Cardiology, General Medicine, Gastroenterology, Orthopedics, and General Surgery

10. Expected Mortality - FY 2008 Expected = 1.00

11. Access to Unique Services • The region’s leading comprehensive program, with a multidisciplinary team of ten board-certified high-risk prenatal MFM specialists more than any other regional health system. • OSUMC has the only dedicated Medical and Surgical Intensive Care units (MICU, SICU) in central Ohio, offering comprehensive services and specialties. • Ohio State’s MICU and SICU rank among the nation’s top performers, according to a UHC comparative study. • OSUMC has the only adult burn center in central Ohio, and is part of a Level 1 Trauma Center • Designated a Center of Excellence in 2006 by the American Society for Metabolic and Bariatric Surgery.

12. Access to Unique Services • Ohio State’s Stroke Center is the only center in Ohio to be Joint Commission certified as a Primary Stroke Center and CARF accredited as a Stroke Specialty program and Stroke Outpatient Rehabilitation program. The stroke team is on-site and available 24/7. • Dodd Hall Rehabilitation is consistently recognized as one of the top 10 inpatient rehabilitation programs in the country by U.S.News & World Report. • Home to a new minimally invasive endovascular and vascular surgical suite, one of only a few of its kind in the world designed to treat a variety of brain and spinal cord injuries in the safest and most efficient environment. Patients are now in one room for imaging and the surgical intervention. • Leaders in the diagnosis and treatment of epilepsy offering the largest and most advanced Level 4 epilepsy monitoring unit staffed 24/7 and a range of epilepsy surgical interventions including use of deep-brain stimulation and awake craniotomy.

13. Comprehensive Transplant Program • Ohio State’s transplant center is central Ohio’s only adult transplant program providing patients kidney, liver, pancreas, heart and lung transplants. • Ohio State has performed more than 6,000 transplants in the past 40 years and its kidney/pancreas program is one of the world’s busiest. • First auto-islet cell transplant performed in November 2008 to treat chronic pancreatitis and reduce the development of diabetes. • OSU Medical Center is one of a select group of medical centers in North America approved to process pancreatic islet cells for human transplant. Islet transplantation may cure type 1 diabetes.

14. National Cancer Institutes • The James is one of only 10 other freestanding cancer hospitals recognized by the federal government to be PPS Exempt. • One of only two NCI-designated comprehensive cancer centers in Ohio and the only one in central and southeast Ohio. • Total active clinical trials (diagnostic, treatment and prevention) number 231of which 65 are investigator-initiated…..45 Phase I trials.

15. Performance Measurement • The James measures performance in a variety of areas, working collaboratively with its peer group: • Memorial Sloan-Kettering Cancer Center • M.D. Anderson Cancer Center • City of Hope National Medical Center • Dana-Farber Cancer Institute • Fox Chase Cancer Center • H. Lee Moffitt Cancer Center & Research Institute • Roswell Park Cancer Institute • Sylvester Cancer Center • Seattle Cancer Care Alliance

16. Cancer Care Integration by Specialty

17. Patient StoryCarl Stewart

18. Only free-standing academic heart hospital / cardiopulmonary research institute combination in the U.S. Davis Heart & Lung Research Institute contains 100,000 square feet of research space with > 50 funded investigators Ross Heart Hospital represents one-stop shop for all cardiovascular services Cardiovascular Medicine & Surgery

19. Sub-specialized approach to care Integrated multidisciplinary programs, e.g. Heart Failure (CV Medicine & Cardiac Surgery) Vascular Disease (CV Medicine & Vascular Surgery) Sleep Apnea and CVD (CV Medicine & Pulmonary) Congenital Heart Disease (OSUMC & Children’s) Arrhythmia Mgmt. (CV Medicine & Cardiac Surgery) Metabolic Syndrome (CV Medicine, Endocrinology, Family Medicine, & Pharmacy Emphasis on evidence-based practice Focus on quality and outcomes Cardiovascular Medicine & Surgery

20. Cardiovascular Medicine & Surgery Vascular Medicine and Interventions Genetics in Cardiovascular Disease Cardiovascular Imaging Advanced Therapies for Heart Failure CV Disease Database Development Cardiovascular Disease in Women Stem Cell Therapies for CV Disease Invasive Electrophysiology

21. Cardiovascular Medicine & Surgery • In 1999, OSUMC became the first site in the United States to perform a robotic heart procedure using the Da Vinci Surgical System. Today, surgeons perform endoscopic coronary artery bypass procedures and the world’s first robotic, beating heart MAZE procedure, a procedure used to treat atrial fibrillation. • Ohio State offers one of the nation’s largest ventricular assist device programs, enrolling more patients in the Thoratec HeartMate II trial than any other site, and one of a handful of programs in the United States to offer the total artificial heart implant. • Vascular surgeons have seen a 50 percent growth in endovascular treatment of infrarenal and thoracic aortic aneurysms as well as endovascular approaches to treatment of lower extremity arterial disease.

22. Regional STEMI Program

23. Heart Failure Program • Most rapidly growing form of heart disease • Prevalence of >5 million Americans • 500,000 new patients diagnosed each year • Most common DRG for those >65 years • Treatment options • Medical therapy • 20-30% 2 year survival (NYHA class IV) • Device therapy • Transplantation • Approaching 70% 5 year survival

24. Advanced Therapy for Heart Failure William Abraham, MD; Philip Binkley, MD, MPH; Juan Crestanello, MD; David Feldman, MD, PhD; Veronica Franco, MD, MPH; Garrie Haas, MD; Ayesha Hasan, MD; Carl Leier, MD; Sai Sudhakar, MD, Benjamin Sun, MD; Industry Sponsored Trials NIH/NHLBI Sponsored Trials CardioMEMs sensor CHAMPION HeartNet PEERLESS HF HeartPOD HOMEOSTASIS II Orqis MOMENTUM Chronicle ICD REDUCEhf

25. SAVACOR, INC LA RA New Approach to Managing Heart Failure

26. Why Mechanical Support? • > 5,000 patients listed for cardiac transplantation in the United States* • 20-30% per year die waiting • < 3,500 cardiac transplants performed per year worldwide* • Unchanged since 1989 • Mechanical support can provide viable options as alternatives to transplantation * ISHLT database

27. VAD Procedures per Year

28. STS Observed/Expected Mortality Ratios • In 2008, the Mortality rate for Coronary Bypass Surgery at OSUMC was 73% better than our expected rate* • Rates for Bypass, Valve, or Bypass Valve Combo Surgery was 41% better than expected* *Source: Society of Thoracic Surgery

29. AmericanCollege of Cardiology standard states that no more than 20-25% of total cardiac catheterization procedures performed should be considered “Normal” Source: MedInfo (calendar year 2006 through 2008) Normal Outcome % for Heart Catheterizations Rate of “Normal” Cardiac Catheterizations

30. The Ohio State University Medical Center March 3, 2009 Ohio School Employees Health Care Conference