The Ohio State University Medical Center

March 3, 2009

Ohio School Employees Health Care Conference

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

Columbus Hospitals Outperformed Ohio and National Average in ‘08

OSU Columbus Ohio Nation

Heart Attack (8 Measures) 99 97 89 88

Heart Failure (4 Measures) 98 98 89 84

Pneumonia (7 Measures) 90 93 91 88

Surgical Care (7 Measures) 97 92 89 86

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.

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

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.

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

Integration of Research and Clinical Practice

Clinical Question

Basic Bench Research

Translational Application

DevelopmentClinical Research Protocol

Clinical Protocol Standard of Care

Quality Assessment

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

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

Expected Mortality - FY 2008

0.71 0.74 0.74 0.760.82 0.82

0.88 0.89 0.920.97 0.97 0.97 0.99

1.04 1.05 1.051.15

0.0

0.5

1.0

1.5A B

OS

UM

C D E F G H I J K L M N O P Q

US News Honor Roll Hospitals in UHC Database

Mo

rta

lity

Ind

ex

Expected = 1.00

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.

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.

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.

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.

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

Gastrointestinal Surgery

Endocrinology

Dermatology

Pulmonary

Palliative Medicine

Neuro Surgery

Neurology

Otolaryngology

Radiation Medicine

Radiology

Thoracic Surgery

Plastic SurgeryPathology

Solid Tumor Oncology

Hematology

Orthopedic OncologyUrologic Surgery

GYN/Oncology

Neurology

Neuro Surgery

Palliative Medicine

Otolaryngology

Radiation Medicine

Radiology

Thoracic Surgery

GYN/Oncology

Orthopedic Oncology

Urologic Surgery

Hematology

Solid Tumor Oncology

Pathology

Plastic Surgery

Gastrointestinal Surgery

Endocrinology

Pulmonary

Dermatology

Cancer Care Integration by Specialty

Patient StoryCarl Stewart

• 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

• 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

Cardiovascular Medicine & SurgeryCardiovascular Medicine & Surgery

Cardiovascular Cardiovascular ImagingImaging

Genetics in Genetics in Cardiovascular Cardiovascular

DiseaseDisease

Vascular Vascular Medicine and Medicine and InterventionsInterventions

Cardiovascular Cardiovascular Disease in Disease in

WomenWomen

CV Disease CV Disease Database Database

DevelopmentDevelopment

Advanced Advanced Therapies for Therapies for Heart FailureHeart Failure

Invasive Invasive ElectrophysiologyElectrophysiology

Stem Cell Stem Cell Therapies for CV Therapies for CV

DiseaseDisease

• 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.

Cardiovascular Medicine & Surgery

Regional STEMI ProgramTotal Receiving Tratement within 90 Mintues

95.7%

75.0%

0.0%

10.0%

20.0%30.0%

40.0%

50.0%

60.0%

70.0%80.0%

90.0%

100.0%

OSUMC National

Total Receiving Tratement within 90 Mintues

Total Patients

Total Receiving Treatment within 90 Mintues

Total Receiving Treatment within 90 Mintues

Average Time to

TreatmentOSUMC 47 45 95.7% 46 MinutesNational 75.0% 101 Minutes

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

Advanced Therapy for Heart FailureWilliam 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;

HeartNetHeartNetPEERLESS HFPEERLESS HF

HeartPODHeartPODHOMEOSTASIS IIHOMEOSTASIS II

OrqisOrqisMOMENTUMMOMENTUM

Chronicle ICDChronicle ICDREDUCEhfREDUCEhf

NIH/NHLBI NIH/NHLBI Sponsored TrialsSponsored Trials

Industry Industry Sponsored TrialsSponsored Trials

CardioMEMs sensorCardioMEMs sensorCHAMPIONCHAMPION

LARA

SAVACOR, INCSAVACOR, INC

New Approach to Managing Heart Failure

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

VAD Procedures per Year

0

10

20

30

40

50

60

2004 2005 2006 2007 2008

Short Term

Long Term

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*

CY 2008 Mortality Index

0.370.59

0.00

1.00

2.00

Bypass SurgeryAlone

Bypass, Valve orCombo

*Source: Society of Thoracic Surgery

Rate of “Normal” Cardiac Catheterizations

4%

25%

0% 5% 10% 15% 20% 25% 30%

OSUMC

Maximum Normal Cath Rate

American College 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

The Ohio State University Medical Center

March 3, 2009

Ohio School Employees Health Care Conference