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Transcript of Confidential. This presentation is provided for the recipient only and cannot be reproduced or...
Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Health Management Associates, Inc.’s express consent.
© 2011 Health Management Associates, Inc. 1
Strategic Initiative with
and
© 2011 Health Management Associates, Inc. Confidential.2
• Health Management’s Mission of Enabling America’s Best Local Healthcare – Our focus is supporting South East Volusia communities
• Health Management’s state wide presence in Florida and locally on the East Coast connecting physicians and hospitals systems like Bayfront, Shands, and Orlando Health
• Health Management’s results for being a leader in both quality driven health care and healthy operations
Partnership Benefits for Bert Fish Medical Center and South East Volusia County
© 2011 Health Management Associates, Inc. Confidential.3
Bert Fish Medical Center Proposal Highlights
• Health Management leases assets and operations of Bert Fish Medical Center for $50,000,000 in cash, spends at least $40 million in capital spending and offers Joint Venture option which includes 50/50 Governance
• Pay annual property taxes like all other businesses and end community health care tax after 7 years
• All staff employees stay at same title and pay
• Bert Fish Medical Center keeps its charity care policy and mission to serve the poor
• Clinical Affiliation with Orlando Health
© 2011 Health Management Associates, Inc. Confidential.4
Mission and Vision
• About Health Management
• Mission, Vision, and Values
• Quality
Gary Newsome President and Chief Executive Officer
Enabling America’s Best Local Health Care
© 2011 Health Management Associates, Inc. Confidential.5
Guiding Principles
PEO
PLE
SER
VIC
E
QU
ALIT
Y
INN
OV
ATIO
N
FINA
NC
E
GR
OW
TH
MISSION:ENABLING AMERICA’S BEST LOCAL HEALTH CARE.
We are servant leaders.
We do the right thing.We don’t settle.
© 2011 Health Management Associates, Inc. Confidential.6
•One of world’s most admired companies in Health Care
•No. 1 company in Quality of Products / Services
•No. 1 in Social Responsibility
States with Health Management Presence
Not-for-profit Joint Ventures / Affiliations
• 70 facilities in 15 states
• +40,000 Associates
• +10,000 Physicians
• A focus on mid-sizedcommunities
• Located primarily inthe Southeastern U.S. including 22 hospitals in Florida
• Strong presence in markets with high retirement populations
About Health Management
© 2011 Health Management Associates, Inc. Confidential.7
Shands: Lake Shore, Live Oak, Starke
Wuesthoff - Rockledge
Wuesthoff - Melbourne
Sebastian River
St. Cloud RMC /Orlando Health
Bayfront Medical Center
Bert Fish Medical Center
Health Management
Hospitals (FY 2011)
22 (FL)
Total Beds 2,998
Admissions 132,000
Surgeries 116,000
ER Visits 575,000
Net Revenue $2.08B
Florida Network of Hospitals
© 2011 Health Management Associates, Inc. Confidential.8
Health Management AssociatesLocal Hospitals, National Recognition
• 58 hospitals/health systems are Joint Commission accredited and have received The Gold Seal of ApprovalTM.
• 41 hospitals/health systems were recognized as 2011 Top Performers on Key Quality MeasuresTM by The Joint Commission.
• 7 hospitals/health systems are certified as Primary Stroke Centers by The Joint Commission.
• 18 hospitals/health systems have received chest pain center accreditation by the Society of Cardiovascular Patient Care (formerly known as the Society of Chest Pain Centers).
© 2011 Health Management Associates, Inc. Confidential.9
Vision for Nursing:Perspective from Six Pillars at Health Management
• People» Clinical Leader Program
» Development of ACNO Program
» CNE Orientation and Development
» CNE Annual Conference
» National Nursing Leadership Group
• Service and Quality» Alignment with disciplines throughout the company to enhance quality
outcomes Nursing leads Corporate Patient Safety Committee Nursing Sensitive Scorecard Patient Safety Scorecard Disseminate best practices through various mechanisms Development of local collaborative interdisciplinary team model
© 2011 Health Management Associates, Inc. Confidential.10
Information Technology Integration
• Information Technology Integration » Base system integrates with existing platforms
including Meditech
• Hospital » Base system integrates with other ancillary, billing,
and financial systems with minimal disruption
• Physician Clinics» Athena Health for EMR and practice management
systems
• Meaningful Use – Fully implemented in 2012
© 2011 Health Management Associates, Inc. Confidential.11
Bert Fish Medical Center Strategy
• HMA East Coast Network• Market Share Opportunity• Quality Outcomes• Managed Care and Accountable
Care• Business Plan
Kathy BurkeDivision CEO South Florida
© 2011 Health Management Associates, Inc. Confidential.12
Health Management AssociatesLocal Hospitals, National Recognition
Florida Recognition
•Six hospitals/health systems (seven locations) are certified as Primary Stroke Centers by AHCA (Agency for Health Care Administration).
•Five hospitals are certified as Primary Stroke Centers by The Joint Commission.
•Three hospitals/health systems (three locations) have received chest pain center accreditation by the Society of Cardiovascular Patient Care; one hospital with chest pain accreditation by AHCA
•13 hospitals were recognized as 2011 Top Performers on Key Quality MeasuresTM by The Joint Commission.
© 2011 Health Management Associates, Inc. Confidential.13
Health Management AssociatesLocal Hospitals, National Recognition
Florida Medical Quality Assurance Inc. - Patient Safety Award 2008-2011
First and only Certification Gynecological Surgical Center of Excellence in Florida; Only comprehensive stroke center in SW Florida
HealthGrades: America’s Best 100 Hospitals, 2012 Distinguished Hospital Award for Clinical Excellence 2010, 2011, 2012
Blue Distinction for Hips and Knees by Florida Blue (2012); Breast Imaging Center of Excellence by the American College of Radiology (2012)
Get With the Guidelines Stroke Gold Plus Award and Heart Failure Silver Award
© 2011 Health Management Associates, Inc. Confidential.14
Health Management in Florida’s East Coast
Melbourne
Rockledge
Sebastian
Health Management Hospitals Admissions Surgeries ER Visits Net Revenue
Wuesthoff - Rockledge 12,707 7,926 37,348 $206.4M
Wuesthoff - Melbourne 5,318 6,115 21,231 $114.8M
Sebastian Regional 4,660 5,591 19,281 $ 81.6M
© 2009 Health Management, Inc. Confidential.15
Health Management East Coast Physician Network
•A Different Business with Different Metrics requiring Different Leadership
•Provide physicians with viable bestpractice options
•Over 1,500 medical staff physicians
•113 physician & midlevel associates
•More than 375 associates
•64 locations throughoutSpace Coast
•350,000 annual patientencounters
•$59.2 Million Net Revenue
© 2011 Health Management Associates, Inc. Confidential.16
Patient Egress from South East Volusia
HospitalPSA/SSA
Bert Fish Medical Center
31.7
Halifax Health Med Ctr 34.5
Florida Hospital Memorial
11.9
Halifax Health Port Orange
8.7
All Others 13.2
Source: Florida inpatient data Jan 2011-Dec 2011
The Nielsen Company & Thomson Reuters
Nearly 70% of patients from South East Volusia county leave the area for patient care services
© 2011 Health Management Associates, Inc. Confidential.17
Health Care Quality Data Opportunities for Improvement
Risk-Adj Mortality Composite%*
Core Measures Mean Percent* HCAHPS Score % Top Box**
Sources: * Whynotthebest.org 2-21-13 ** Hospitalcompare.com 2/21/13
© 2011 Health Management Associates, Inc. Confidential.18
Improving Quality and Customer Satisfaction at Bert Fish Medical Center
• Bench mark quality and operations results for hospital and medical staff with 70 other hospitals and 10,000 physicians
• Collaborate with Health Management’s Florida hospitals for best practices in quality and operations
• Adopt advanced Clinical Protocols from Orlando Health and Shands Healthcare in Chest Pain and Stroke to expand facility services
© 2011 Health Management Associates, Inc. Confidential.19
Managed Care –Keeping Bert Fish Independent and Connected
Strategic Responses to New Payment Methodologies
Value Based Purchasing
Hospital-Physician Bundling
Shared-Savings Model
Degree of Management
Challenge
• Engage physicians• Standardize care processes• Engage patients• Track and analyze performance• Leverage physician incentives
• Standardize devices
• Implement care maps
• Reduce orders and consults
• Implement evidence base guidelines
• Disease Registries
• Care Managers
• Partner with PCPs
• Deliver preventive & chronic disease management
• Reduce utilization
Actions needed under all payment reforms
Provider Cost Accountability
Pay-for-Performance
Source: Advisory Board
© 2011 Health Management Associates, Inc. Confidential.20
Bert Fish Medical Center Business Strategy
•Adding Bert Fish to Health Management’s Statewide and Local Insurance Plan Networks including future ACOs with Orlando Health and Shands Healthcare
•Establish large network of Primary Care Physicians including private and employed physicians and free standing ERs North and South of Bert Fish Medical Center
•Enhance Service Lines – Capital Spending and Physician Recruitment
» Cardiology – Expand and Market Chest Pain Center
» Stroke – Expand and Market Stroke Center
» Surgery – Add robotics services for Orthopedics and daVinci
© 2011 Health Management Associates, Inc. Confidential.21
Partnership Proposal
• Business Terms
• Joint Venture Option
• Governance
Pete LawsonExecutive Vice President
Enabling America’s Best Local Health Care
© 2011 Health Management Associates, Inc. Confidential.22
Bert Fish Medical Center Proposal Highlights
• Health Management leases assets and operations of Bert Fish Medical Center for $50,000,000 in cash, spends at least $40 million in capital spending and offers Joint Venture option which includes 50/50 Governance
• Pay annual property taxes like all other businesses and end community health care tax after 7 years
• All staff employees stay at same title and pay
• Bert Fish Medical Center keeps its charity care policy and mission to serve the poor
• Clinical Affiliation with Orlando Health
© 2011 Health Management Associates, Inc. Confidential.23
Estimated Flow of Funds to SE Volusia Hospital District
Cash From Lease Payment $50,000,000Plus Inventory and Pre-Paids 2,600,000 Total Cash From HMA $52,600,000
+Plus Current Assets 23,200,000+Plus Limited and Other Assets 8,500,000
Less Current Liabilities (12,600,000)Long Term Debt (21,500,000)
Net Proceeds Following Transaction $50,200,000
Notes: August 31, 2012 unaudited balance sheet Pension obligation not required to be paid off at closing
© 2011 Health Management Associates, Inc. Confidential.24
Bert Fish Medical Center Governance
• Advisory Board permanent seats include designated:
» One (1) Southeast Hospital District Member
» One (1) Bert Fish Foundation Member
© 2011 Health Management Associates, Inc. Confidential.25
Bert Fish Medical Center Advisory Board
• Comprised of Local Community Leaders, Physician Representatives and Hospital CEO» Typically comprised of 9-13 members: 60% lay members and 40%
physicians
» One (1) permanent member of the District and one (1) from the Bert Fish Foundation
• Establishes strategic direction
• Oversight for regulatory compliance (JCAHO, State, CMS) and patient safety
• Ensures quality of care and Medical Staff credentials
• Collaborates on operational objectives
• Serves as community liaisons and communication champions
© 2011 Health Management Associates, Inc. Confidential.26
Clinical Component
•Access to Teaching Center Physicians
•Disease Management Protocols
•Clinical Trials
•Clinical Care Guidelines
•Telemedicine
Business Component
• Common Branding and Shared Logo
• Physician Recruitment
• Service Expansion
• Capital Spending
• Network Platform
Health Management Not-for-Profit Partnerships
© 2011 Health Management Associates, Inc. Confidential.27
Health Manageme
nt Associates
BFMC, LLC
Joint Venture Option – 80/20 Ownership and Equal Governance
» SEVHD receives accelerated lease payment and new NFP holds 20% interest of BFMC, LLC
» SEVHD maintains equal governance with Health Management of BFMC, LLC
» Creates BFMC, LLC which holds assets and operations of BFMC
» Health Management contributes cash and receives 80% interest of BFMC, LLC
» Health Management manages LLC LLC Ownersh
ipGovernan
ce
HMA 80% 50
SEVHD
20% 50
Equal Governance
SEVHD receives cash and leases BFMC assets and operations to HMA and New Not For Profit holds 20%
SEVHD – New Not For Profit
© 2011 Health Management Associates, Inc. Confidential.28
Bert Fish Medical Center, LLC Board of Directors Governance
• Comprised of 4 Health Management and 4 SE Volusia Hospital District Members governing jointly
• Major, Majority, and Unanimous Decision Rights detailed in Operating Agreement including:» Annual Operating and Capital Budgets
» Acquisition of other businesses
» Capital calls
» Debt defeasement or addition
» Distribution amounts
» New Member additions
» Dissolution and Unwinds
» Puts and Calls
© 2011 Health Management Associates, Inc. Confidential.29
Estimated Partnership Flow of Funds to SE Volusia Hospital District
Cash From Lease Payment $50,000,000Plus Inventory and Pre-Paids 2,600,000 Total Cash From HMA $52,600,000
+Plus Current Assets 23,200,000+Plus Limited and Other Assets 8,500,000
Less Current Liabilities (12,600,000)Long Term Debt (21,500,000)
-Less 20% ownership of Joint Venture (10,500,000)
Net Proceeds Following Transaction $39,7000,000
Notes: August 31, 2012 unaudited balance sheet Pension obligation not required to be paid off at closing
© 2011 Health Management Associates, Inc. Confidential.30
Ending Health Care Tax (HMA) v. Keeping Tax (Halifax)
© 2011 Health Management Associates, Inc. Confidential.31
• Health Management’s Mission of Enabling America’s Best Local Healthcare – Our focus is supporting South East Volusia communities
• Health Management’s state wide presence in Florida and locally on the East Coast connecting physicians and hospitals systems like Bayfront, Shands and Orlando Health
• Health Management’s results for being a leader in both quality driven health care and healthy operations
Partnership Benefits for Bert Fish Medical Center and South East Volusia County
© 2011 Health Management Associates, Inc. Confidential.32
Discussion and Feedback
© 2011 Health Management Associates, Inc. Confidential.33
Sherrie Sitarik – CEOOrlando Health
Orlando, FL (407) 841-5203
Tim Goldfarb – CEOShands Healthcare
Gainesville, FL(352) 265-8000
James Keaton, MD - Vice-Chancellor
University of MississippiMedical Center
(601) 984-1010
David Knowiski – VP of Finance
Catholic Health PartnersCincinnati, OH
(513) 639-2722
Bruce Lawrence – CEOIntegris Health
Oklahoma City, OK(405) 949-3177
Steve Dupre – Vice ChairmanBayfront Medical Center
St. Petersburg(727) 824-0017
Partnership References
© 2011 Health Management Associates, Inc. Confidential.34
Case Study:University of Florida / Shands Healthcare Partnership
• Health Management Invested Capital in Yr 1: $6M
» Public Hospital Authority contributed additional $2M for renovations
» Renovated ICU
» Renovated first floor
» da Vinci robotic surgery
» Open MRI
• New Services
» Recruited 16 new physicians
» Live Oak - Cardiology
» Starke – General Surgery, Gyn
» Lake Shore – Interventional Radiology, Neurology, Orthopedics
• Health Management acquired 60% ownership in 2010
» Shands Lake Shore, Live Oak, and Starke
» Both organizations share governance equally
» Health Management manages the partnership
» State wide Chest Pain and Stroke programs
Shands Lake Shore Regional Medical Center
© 2011 Health Management Associates, Inc. Confidential.35
Case Study:St. Cloud Regional Partnership
• Capital Invested ($16M since ‘06)
» Land Acquisition for MOB (4.56 acres)
» GE 64-slice CT Scanner
» OR Expansion: 4 MIS ORs
» ER Renovation/New Fast Track
» Digital Mammography
» Da’Vinci Robotic Surgery
• New Services
» Recruited 24 new physicians (‘09-12)
» Wound Care w/ HBOT
» ENT, Ophthalmology & Uro-gynecology
» Partnerships with Jewett Orthopaedic Clinic & Orlando Heart Institute
» Developing Outpatient Center in Lake Nona including ASC, Urgent Care, Imaging Center and Physician Offices
• 84 bed hospital formerly part of the Orlando Regional Health System
• Health Management acquired 80% majority interest in 2006
• Current Projects under development: Build New 24 Bed ED and Cardiac Cath Lab
© 2011 Health Management Associates, Inc. Confidential.36
Case Study:Wuesthoff Health System – Rockledge & Melbourne, FL
• Vertical Integration
» Assisted Living Centers
» Nursing Homes
» Skilled Nursing Facilities
» Home Care
» Hospice & Palliative Care
» Acute Care
» Surgery and Imaging Centers
» Home Medical Equipment
» Regional Reference Lab
• Physician Relationships
» Focus on “splitter” physicians
» 83 employed physicians
» Recruited Osler Medical Group
» 47 multi-specialty physicians
WuesthoffRockled
geMelbour
neTotal
Beds 298 115 413
FTEs 1,850 750 2,600
Discharges 12,830 5,320 18,150
Births 600 420 1,020
Surgeries 7,690 5,470 13,160
ER Visits 35,650 21,075 56,725
Net Revenue
$226M $92M $318M
Wuesthoff Health System – Rockledge
Fiscal Year 2011