UCHC Facility Review Project Strategic Facilities Planning Working Group Briefing: Revised Forecast...

UCHC Facility Review Project

Strategic Facilities Planning Working Group Briefing: Revised ForecastMay 2, 2005

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CONFIDENTIAL PRELIMINARY DRAFT

This Report is Part of a Larger Process

Determine Strategy for

Securing Approvals and

Financing

Develop Financial Forecast, Conduct

Debt Capacity Analysis, and

Identify Sources of Capital

Determine Optimal Configuration of Additional Beds,

Needed Renovations, and

Capital Costs

Estimate Ten Year Demand for Additional Beds

at John Dempsey Hospital

Today Next Session

CSC & Ballinger’s Engagement

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Executive Summary• UCHC should plan to add about 80-90 beds to accommodate population

growth in its primary service area and adjacent areas.

• UCHC has shown vigorous growth since 2001 in both Signature Programs and other programs. In fact, UCHC has grown more rapidly in its non-signature programs. A straight line trend in share growth in the Primary Service Area, and lesser growth in share in nearby service areas is a reasonable assumption given recent performance. This demand based forecast ties closely to the supply-side forecast made in the Signature Program plans

• This forecast also takes into account the significant population growth, most of which will be in the 45-64 and 65+ age groups. These groups use the most medical and hospital services, and the utilization rates of these groups is accounted for in the forecast methodology

• To achieve these improvements in share, UCHC will need to – hire all the planned recruits in each of the Signature Program plans and make

other enhancements to these programs– Develop a larger cadre of loyal primary care physicians, both through

collaboration with community physicians and a most increase in primary care physicians in UMG

– Expand its marketing efforts, especially the physician “detailing” program

4


Scope of Engagement

• Review internal UCHC forecast for inpatient beds

• Confirm or modify bed forecast as necessary– Accounting for trends in utilization, technology changes,

market capture, and population growth

• Confirm or modify scope of new construction and renovation, including design and layout

• Confirm or modify cost projections for design and construction

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Motivation for Work• High Occupancy and Stress at Peak Times

• Development and growth of Signature Programs

• Space inadequacies– Patient privacy/confidentiality – double rooms and windows facing

the inside of floor as well as visible computer screens at nursing stations

– Safety – poor lighting, sinks, handrails and patient bathrooms as well as difficulty removing patients from rooms during emergent situations

– Inadequate room for families – including waiting rooms, kitchens, and visiting space in patient rooms

– Work space – inadequate computer stations and charting areas, no private area for rounds, no staff lounges, and no office space

– Lack of storage space– Noise – due to hard surfaces and open areas

• Need to vet expansion estimates for financing and CON purposes

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Current Facility – Bed Allocation• Overall, adjacencies are lacking in the patient tower with the surgery

floor and ORs on the far ends of the tower, psychiatry split between two floors, and the cancer floor a distance away from the Cancer Center

• Cardiology however has good adjacencies with its step down beds on the same floor as the Cardiology Center

FLOOR UNIT BED CAPACITY SERVICES

7 Surgery 28

6 Cancer 22

5 CMHC (Prison Unit) 12

4 Medicine 29

3 Psychiatry 14

2 ICU + Cardiac Step Down 15 + 14 Lab, Pharmacy, Cardiology

1 Psychiatry 20

M ED, Radiology, Cancer

G Maternity + Newborn/NICU 20 + 50 Radiation Therapy

B OR

SB

Total 224 beds

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Current Base of Admissions and Beds

The starting point for this analysis is 224 beds and 8,704 discharges (FY 2004).

Service Line

2004 JDH Days

2004 JDH Disch.

JDH 2004 Market

Share %

Original 2004 Bed Need Based on

75% utilization & patient days

CANCER 2,333 492 3.4% 8.5CARDIOLOGY 5,134 1,434 2.1% 18.8MEDICINE 12,010 2,370 1.8% 43.9MUSCULOSKELETAL 3,948 1,324 3.8% 14.4OBSTETRICS 4,242 810 1.8% 15.5PSYCHIATRY 8,199 1,034 3.9% 30.0SURGERY 7,854 1,240 2.5% 28.7GRAND TOTAL 43,720 8,704 2.4% 159.7

Total 2004 Licensed Beds, net of NICU/Nbn 174

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Prior Bed Planning Model

Source: UCHC Planning.

10 YearProduct Demographic

# beds location min max avg min max avg Impact New Avg New # beds

Cariology, Cardiac Surgery 14 Cardiac 2 17 9.8 14% 121% 70% 15% 11.3 16.1 Cancer, Med/Surg Onc 22 Hem/Onc 3 23 13.8 14% 105% 63% 18% 16.2 26.0 Med/Surg/Card/Onc 15 ICU 1 13 7.9 7% 87% 53% 20% 9.5 18.0 Maternity 20 Maternity 3 20 11.1 15% 100% 56% -5% 10.6 19.0 Medicine 29 Med 4 11 29 21.8 38% 100% 75% 15% 25.1 33.4 CMHC 12 MedSurg 5 1 12 7.2 8% 100% 60% 0% 7.2 12.0 Newborn 50 Nbrn+NICU 22 60 40.6 44% 120% 81% -2% 39.8 49.0 Psychiatry 34 Psy 1 +3 7 48 23.6 21% 141% 70% 5% 24.8 35.7 Surgery 28 Surg 7 9 29 20.7 32% 104% 74% 14% 23.6 31.9

224 TOTAL 121 189 156.6 54% 84% 70% 168.1 241.0

ProductNew # Beds location

New # beds

Cariology, Cardiac Surgery 16.1 Cardiac 32.2 Cancer, Med/Surg Onc 26.0 Hem/Onc 51.9 Med/Surg/Card/Onc 18.0 ICU 36.0 Maternity 19.0 Maternity 19.0 Medicine 33.4 Med 4 58.4 CMHC 12.0 MedSurg 5 12.0 Newborn 49.0 Nbrn+NICU 49.0 Psychiatry 35.7 Psy 1 +3 35.7 Surgery 31.9 Surg 7 63.8

241.0 TOTAL 358.0

J DH Current Days Occupancy

MktShare/SigPro Impact100%100%100%0%

100%

75%0%0%0%

• UCHC based its future bed capacity on current usage, Solucient growth rates by program and area, and the impact from signature program ramp-up and marketing

• Solucient growth rates included the effects on discharges for technology and aging trends

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Potential Limitations of Prior Model• Does not account for current differences in signature program

penetration and existing distribution strategies by geographic region, and therefore does not fully account for differences in JDH’s ability to attract patients from various service areas in the state

• Solucient service lines do not tie precisely to Signature Programs

• Solucient’s adjustments for technology changes are not transparent, and may not be appropriate for this setting

• Current occupancy rates of 70% or less assumed: these may be vulnerable to challenge, especially in medicine and surgery (although lower occupancy rates in maternity, NICU, and CMHC could be justified).

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FY 2004 JDH Discharges & Patient Days

by Age Cohort and Town

Demo. Projected JDH Discharges &

Patient Days by Age Cohort and

Town

Solucient Data for Population Growth by Age Cohort and CT

Town

Demo. + Market Projected JDH Discharges &

Patient Days by Age Cohort and

Town

Market share Capture

Analysis from Other Hospitals by Geo. Area

Total Projected JDH Facility

Needs

Assumptions/ Projections on

Utilization Statistics & Technology

Data points Analyses

Operating Room Analysis on Volume and

Utilization

Approach to Estimating Capacity

Final Output

Group Towns by Geo. Area

CSC analyzed discharge data and population growth by age cohort at the town level, then aggregated the data into coherent service areas in the state. We were then able to apply varying estimates of JDH’s ability to capture share from each service area (depending on proximity, existing share, and existing strategies to capture patients. Explicit adjustments for technology change by program were made.

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CT Population Growth 2004-2014

2004

2009

Solucient AGS US Census

3,501 3,507 3,486

3,621 3,626 3,564

% Change 3% 3% 2.26%

The slightly higher growth forecast by the private population forecasting services account for additional state-specific, such as deliverable addresses from USPS, and household counts from local taxing authorities. These adjustments are not made in the US Census forecast. The consistency between the two private services suggest that these adjustments are appropriate.

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CT Population Growth in Older Age Cohorts

2004

2009

45-64 65+

842.0 469.5

920.5 502.2

% Change 9.3% 6.9%

45-64 65+

885.5 476.3

975.5 508.7

10.2% 6.8%

Solucient US Census

With the state-specific changes, the Solucient’s estimate of the size of the 45-64 and 65+ age groups in 2004 is estimated to be somewhat smaller than the US Census estimate. The growth forecasts by Solucient and the US Census for the 45-64 and 65+ age groups are similar. Thus, the use of the Solucient population size and growth in these age growths form a conservative basis to the bed forecast.

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Geographic Regions

Central Primary /

Secondary

Central Primary /

SecondaryNortheastNortheast

SoutheastSoutheast

CoastCoast

I-84 I-84 CorridorCorridor

NorthwestNorthwestWestWest

SecondarySecondary

East East of CT of CT RiverRiver

Route 9 Route 9 CorridorCorridor

In addition to the primary/secondary service area, the other areas were defined by ease of travel and other hospitals’ primary service areas.

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CT Geographic Region Description• Central Primary / Secondary – JDH’s main region for patient draw – west of the

Connecticut River

• West Secondary – the western portion of JDH’s secondary market, potentially a focus point for outreach. JDH has second largest share among the regions.

• East of CT River – potential area for targeted marketing as it is believed that patients tend not to cross the CT River for care. JDH has third largest share among the regions.

• I-84 Corridor – this area has easy access to JDH via I-84, making it a potential focus point for outreach

• Rt. 9 Corridor – this area has access to JDH via Rt. 9, making it a potential focus point for outreach

• Coast – southwestern section of CT along I-95 and Merritt Parkway with access to many other hospitals, including St Vincent’s, Yale, and St. Raphael

• Southeast – New London county which has minimal access to JDH via any major highways

• Northeast – Tolland and Windham counties where patients must drive through Hartford to get to JDH

• Northwest – Litchfield county (less zip codes in secondary market) market does not have a large population nor a good means of accessing JDH

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Overall Market Share1 by Geographic Region

Southeast

Hospital MS

Lawrence & Memorial 46.3%

Backus 34.2%

Yale 7.4%

JDH 0.7%

I-84 Corridor

Hospital MS

Danbury 27.2%

Waterbury 22.6%

St. Mary 19.3%

JDH 0.6%

Northwest

Hospital MS

New Milford 38.9%

Danbury 16.6%

C. Hungerford 11.7%

JDH 1.7%

West Secondary

Hospital MS

C. Hungerford 54.6%

Hartford 9.9%

Bristol 9.8%

JDH 5.4%

Route 9 Corridor

Hospital MS

Middlesex 56.0%

Yale 13.1%

Hartford 10.0%

JDH 1.4%

The two regions adjacent to the primary service area have the second and third largest share by region for JDH. Despite ease of travel, the I-84 corridor region has low penetration, due to presence of hospitals in Waterbury and Danbury. The coastal region also has low penetration, due to presence of strong hospitals there, including Yale and St. Raphael’s.

1. Without newborns

East of CT River

Hospital MS

St. Francis 27.0%

Hartford 24.7%

Manchester 23.8%

JDH 2.9%

Northeast

Hospital MS

Day Kimball 26.7%

Windham 19.6%

Hartford 11.1%

JDH 2.1%

Central Primary / Secondary

Hospital MS

Hartford 27.6%

St. Francis 24.5%

New Britain 19.0%

JDH 8.4%

Coast

Hospital MS

Yale 23.6%

St. Raphael 15.8%

St. Vincent’s 12.6%

JDH 0.1%

2004 CHIME data base; CSC analysis.

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Other Med/Surg (non-signature) Share by Geo Region

Southeast

Hospital MS


Backus 35.7%

Yale 5.6%

JDH 0.6%

I-84 Corridor

Hospital MS

Danbury 27.7%

Waterbury 22.5%

St. Mary 21.8%

JDH 0.5%

Northwest

Hospital MS

New Milford 44.4%

Danbury 14.4%

C. Hungerford 12.1%

JDH 1.1%

West Secondary

Hospital MS

C. Hungerford 59.3%

Bristol 11.1%

Hartford 7.1%

JDH 3.6%

Route 9 Corridor

Hospital MS

Middlesex 60.%

Yale 13.3%

Hartford 7.3%

JDH 1.0%

JDH’s share is slightly weaker across the board when signature programs are excluded.

Northeast

Hospital MS

Day Kimball 26.7%

Windham 23.0%

Hartford 9.2%

JDH 1.8%


Hospital MS

Hartford 25.7%

St. Francis 23.3%

New Britain 19.4%

JDH 7.8%

Coast

Hospital MS

Yale 25.0%

St. Raphael 16.8%


JDH 0.1%

East of CT River

Hospital MS

Hartford 24.1%

Manchester 24.0%

St. Francis 22.8%

JDH 2.6%


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Cancer Market Share by Geo Region

Southeast

Hospital MS


Backus 34.5%

Yale 11.8%

JDH 1.4%

I-84 Corridor

Hospital MS

Danbury 30.1%

Waterbury 18.5%

St. Mary 17.4%

JDH 1.1%

Northwest

Hospital MS

New Milford 24.4%

C. Hungerford 19.0%

Danbury 15.8%

JDH 2.7%

West Secondary

Hospital MS

C. Hungerford 60.2%

Bristol 8.7%

Hartford 8.0%

JDH 7.7%

Route 9 Corridor

Hospital MS

Middlesex 52.5%

Yale 15.9%

Hartford 10.2%

JDH 3.4%

Cancer has good penetration across the northern tier of the state, even in the two regions east of the Connecticut River and the Route 9 corridor. This suggests opportunities in those areas. The low penetration in the coastal region and the 84 corridor implies consumers see the hospitals in those regions as adequate.

Northeast

Hospital MS

Day Kimball 19.2%

Hartford 17.0%

Windham 15.6%

JDH 4.8%


Hospital MS

Hartford 29.3%

St. Francis 23.0%

New Britain 17.3%

JDH 11.5%

Coast

Hospital MS

Yale 25.3%

St. Raphael 16.0%


JDH 0.2%

East of CT River

Hospital MS

Hartford 29.4%

St. Francis 24.9%

Manchester 24.4%

JDH 4.9%


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Musculoskeletal Market Share by Geo Region

Southeast

Hospital MS


Backus 38.4%

Yale 5.0%

JDH 1.8%

I-84 Corridor

Hospital MS

Danbury 31.1%

Waterbury 24.6%

St. Mary 16.2%

JDH 1.1%

Northwest

Hospital MS

New Milford 43.5%

C. Hungerford 15.9%

Danbury 11.6%

JDH 5.0%

West Secondary

Hospital MS

C. Hungerford 45.8%

JDH 13.8%

Hartford 8.0%

Route 9 Corridor

Hospital MS

Middlesex 50.8%

Hartford 13.1%

Yale 10.1%

JDH 2.3%

Musculoskeletal, like Cancer has much stronger penetration than JDH overall, particularly in the northern tier of the state. This is a tribute both to the excellence of the sports medicine program, and the unique distribution channels to high school and college sports teams. There is probably an opportunity to leverage these linkages when joint replacement surgeons are added.

Northeast

Hospital MS

Day Kimball 19.2%

Windham 16.8%

Hartford 14.1%

JDH 4.1%


Hospital MS

Hartford 29.6%

St. Francis 23.2%

New Britain 17.2%

JDH 12.1%

Coast

Hospital MS

Yale 19.7%

St. Raphael 16.7%


JDH 0.2%

East of CT River

Hospital MS

Hartford 30.1%

St. Francis 28.2%

Manchester 19.6%

JDH 5.9%


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Cardiology Market Share by Geo Region

Southeast

Hospital MS


Backus 31.1%

Yale 16.8%

JDH 0.2%

I-84 Corridor

Hospital MS

Danbury 23.4%

Waterbury 20.2%

St. Mary 17.3%

JDH 0.5%

Northwest

Hospital MS

New Milford 31.6%

Hartford 16.6%

Waterbury 10.4%

JDH 1.7%

West Secondary

Hospital MS

C. Hungerford 42.9%

Hartford 22.9%

Bristol 8.2%

JDH 5.0%

Route 9 Corridor

Hospital MS

Middlesex 52.6%

Hartford 18.1%

Yale 12.5%

JDH 1.0%

Cardiology share across the regions is not much different that JDH overall, and shows significant differences compared to the penetration of Cancer and Musculo-skeletal. Hartford Hospital, St. Francis and New Britain remain formidable competitors.

Northeast

Hospital MS

Day Kimball 28.5%

Windham 16.8%

Hartford 14.1%

JDH 0.9%


Hospital MS

St. Francis 30.5%

Hartford 23.6%

New Britain 19.9%

JDH 9.2%

Coast

Hospital MS

St. Raphael 19.5%

Yale 19.2%


JDH 0.1%

East of CT River

Hospital MS

St. Francis 38.6%

Hartford 22.0%

Manchester 19.8%

JDH 1.4%


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Overall Growth Rate Forecast by Age CohortWest Secondary

Age P2004 GR

00-17 21,166 4.5%

18-44 29,966 1.3%

45-64 22,996 19.9%

65+ 12,963 14.3%

Total 87,091 8.9%

The growth rates of the age cohorts of 45-64 and 65 and over are very high across the state, presenting significant opportunity for JDH as well as other providers.

I-84 Corridor

Age P2004 GR

00-17 132,224 2.4%

18-44 183,733 0.7%

45-64 124,979 19.4%

65+ 65,927 15.0%

Total 506,863 7.6%

Coast

Age P2004 GR

00-17 323,120 0.8%

18-44 465,064 -1.3%

45-64 311,956 17.8%

65+ 181,056 13.1%

Total1,281,19

65.9%


Age P2004 GR

00-17 164,316 0.2%

18-44 236,026 -1.6%

45-64 162,252 17.3%

65+ 98,707 12.4%

TOTAL 661,301 5.6%

Route 9 Corridor

Age P2004 GR

00-17 36,111 6.5%

18-44 55,386 4.4%

45-64 40,427 22.7%

65+ 21,010 18.4%

TOTAL 152,934 11.7%

Southeast

Age P2004 GR

00-17 63,482 1.8%

18-44 98,276 -1.4%

45-64 62,116 18.9%

65+ 33,188 13.3%

TOTAL 257,062 6.2%

Northwest

Age P2004 GR

00-17 18,322 5.7%

18-44 24,039 3.7%

45-64 20,506 21.6%

65+ 9,617 19.9%

TOTAL 72,484 11.4%

East of CT River

Age P2004 GR

00-17 59,757 -0.1%

18-44 91,988 -2.0%

45-64 62,017 16.0%

65+ 34,518 11.3%

TOTAL 248,280 4.8%

Northeast

Age P2004 GR

00-17 56,368 7.2%

18-44 94,642 5.1%

45-64 57,745 23.9%

65+ 25,433 22.2%

TOTAL 234,188 12.1%

Solucient data; CSC analysis.

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General Assumptions for Scenarios• 75% Occupancy Assumed for med-surg and OB beds

• Population growth for 10 years straight-line extrapolation of Solucient five year population growth forecast

• Included straight-line projections of Cath Lab (previously done by Planning) around ablations, pacemakers, defibrillators, caths, and angioplasty with one day stays

• ICU days based on level of care, not ICU charges, so all ICU need is accounted for

• No growth in prisoner admissions is assumed.

22


Impact of Technology on Inpatient Facility Need

• LOS for CABG assumed to be 5-6 days

• Pacemaker insertion, CHF, and chest pain DRGs all were assumed to have reduced LOS of .5 to 1 day

• 25% of angioplasty cases were assumed to move to the ambulatory setting

• Coronary artery bypass DRGs were reduced 20%

• Angioplasty DRGs were increased 20%

• Pacers, defibs, EP and valves will increase to reflect overall share in PSA and West Secondary

Specific changes in inpatient utilization were assumed in our model.

Cardiology Musculo-Skeletal Cancer

• Some spine surgery DRGs were assumed to have lower LOS

• 25% of spine procedures without complications assumed to move to ambulatory setting

• 50% of medical back admissions to outpatient setting

• 25% of foot procedures to outpatient setting

• No changes in IP utilization were assumed (most cases surgery major, can’t be minimally invasive)

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Recent Historical Growth in JDH Discharges Inpatient Discharges

0

2,000

4,000

6,000

8,000

10,000

12,000

All Other 4,594 5,495 5,823 5,980 6,311

Musculo 948 1,158 1,227 1,316 1,335

Cardio 1,375 1,393 1,390 1,418 1,564

Cancer 624 532 494 666 653

FY 01 FY 02 FY 03 FY 04 FY 05 annualized

Recent growth is an important factor in considering the specific assumptions to be made in the scenarios. The recent growth demonstrates the general attractiveness of JDH.

FY 02 FY 03 FY 04FY 05 annualized

All Other Discharges 19.6% 6.0% 2.7% 5.5%Musculosk Disch 22.2% 6.0% 7.3% 1.4%Cardiology Disch 1.3% -0.2% 2.0% 10.3%Cancer Disch -14.7% -7.1% 34.8% -1.9%Total Discharges 13.8% 4.2% 5.0% 5.1%

% Growth Over Prior Year

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Recent Growth by Service Line

• Cardiology

• Musculo-Skeletal

• Cancer

• Geriatrics

• Medicine

• Surgery

• OB

9.1

10.1

9.7

9.3

7.2

9.5

2.7

10.4

13.1

14.0

11.4

9.1

11.8

5.1

1.3

3.0

4.3

2.1

1.9

2.3

2.4

2001 2004PSA 3 yr %change

2.0

All Service Lines have enjoyed robust growth in share over the last three years in the Primary Service Area.

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Current Patient Capture Strategies• UCHC has embarked on advertising in multiple media during the last 3- 4 years. Since

advent of signature programs, 95% of advertising ties back to signature programs. There is high name recognition from advertising based on phone surveys and increase in self referrals due to advertising, based on interviews with self-referred patients.

• UCHC has also retained staff to do direct in-office physician marketing. Principal areas of concentration are in the primary service area and the West Central area “referring physician focus”. Results show increase in physician referrals tied to area in which staff is working the local doctors.

• Advertising tied to new physician faculty members helps in getting those physicians ramped up.

• “New Movers” current format is a mailing program with materials just about UCHC. It contains action steps: recipients can respond by requesting more information and newsletters. Averages 11% response rate.

• UCHC runs an effective call center. Over 2600 patients had services at JDH after enrollment and 724 patients were new to JDH.

• Celebrate programs are affinity, membership based programs. UCHC markets programs encourage people to sign up, enrollees receive newsletters, discounts to local retail outlets, events.

UCHC patient capture programs are another key factor in considering the assumptions for the scenarios. UCHC has a number of effective marketing and patient capture strategies. There is a balance between direct-to-consumer programs and community physician relationship development programs.

26


Self referrals by Area and Results of ‘Detailing’• Outside of UCHC’s primary service area, many of the referrals come from self referrals and unidentified

physician types. Targeted marketing may aid in increasing self referrals, which are now about 50% of new patient activity to UMG

• West Secondary region has the highest percentage of referrals from outreach activities, while East of CT River has the lowest. Efficacy of outreach is established; program should be intensified in the Primary Service area and expanded to East of the CT River and Route 9 Corridor.

62.5%

27.3%

8.3%

19.1%16.7%16.8%

4.7%

3.6%

0

1,000

2,000

3,000

4,000

5,000

6,000

Eas

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f C

T R

iver

Sel

f R

efer

ral

No

Ad

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No

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ido

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Wes

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Ro

ute

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Co

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wes

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0%

10%

20%

30%

40%

50%

60%

70%

UCHP

ProHealth

UMG

Community

No Physician Type

% of Referrals from Outreach

Source: UCHC database, CSC analysis.

0

5,000

10,000

15,000

20,000

25,000

30,000

Cen

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Pri

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27


Scenario 1: Forecast Ten Year Increase in Share

• Cardiology


• Cancer

• Geriatrics

• Medicine

• Surgery

• OB

9.1

10.1

9.7

9.3

7.2

9.5

2.7

10.4

13.1

14.0

11.4

9.1

11.8

5.1

1.3

3.0

4.3

2.1

1.9

2.3

2.4

4

9

13

6

7

7

3.5

8.1

11.7

5.4

6.3

6.3

2

4.5

6.5

1

3.5

1


PSA 10 yr %change

(straight line)

W.Sec 10 yr %change

(90% PSA)

ECT/Rt 9 10 yr %change

(~50% PSA)

Based upon the documented improvement in share in the Primary Service Area, the recent 3 year trends in share improvement are extrapolated over 10 years. Based on the relative ease of travel and the characteristics of the service lines, share capture is forecasted in West Secondary at 90% of PSA share capture, and about 50% of PSA East of the CT River and in the Route 9 corridor (except Med and OB).

28


Forecasted 10 year Bed Need

Service Line SERVICE LINE2004 JDH

Disch.

JDH 2004 Market

Share %

2014 JDH

Disch.

JDH 2014

Market Share

2014 JDH Med-Surg Days

2014 Med-Surg Beds

2014 JDH ICU

Days

2014 ICU

Beds

2014 Total

Beds (Net NICU)

CANCER CANCER 492 3.4% 1,125 7.2% 5,185 18.9 121 0.4 19CARDIOLOGY CARDIOLOGY 1,434 2.1% 5,002 4.4% 1,896 6.9 5,745 21.0 28MEDICINE MEDICINE 2,370 1.8% 4,553 3.3% 19,684 71.9 1,907 7.0 79MUSCULOSKELETALMUSCULOSKELETAL 1,324 3.8% 2,151 5.8% 5,952 21.7 352 1.3 23OBSTETRICS OBSTETRICS 810 1.8% 1,588 3.2% 7,688 28.1 19 0.1 28PSYCHIATRY PSYCHIATRY 1,034 3.9% 1,097 3.9% 8,922 32.6 9 0.0 33SURGERY SURGERY 1,240 2.5% 2,336 4.4% 12,473 45.6 1,661 6.1 52GRAND TOTAL GRAND TOTAL 8,704 2.4% 17,853 4.5% 61,798 225.7 9,814 35.9 262

With these assumptions, 88 additional beds are required.

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Scenario 2: Forecast Ten Year Increase in Share

• Cardiology


• Cancer

• Geriatrics

• Medicine

• Surgery

• OB

9.1

10.1

9.7

9.3

7.2

9.5

2.7

10.4

13.1

14.0

11.4

9.1

11.8

5.1

1.3

3.0

4.3

2.1

1.9

2.3

2.4

4

9

13

6

7

7

2

4.5

6.5

3

3.5

3.5

1.3

3

4.3

0

2.3

0


PSA 10 yr %change

(straight line)

W.Sec 10 yr %change

(50% PSA)

ECT/Rt 9 10 yr %change

(~33% PSA)

Based upon the documented improvement in share in the Primary Service Area, the recent 3 year trends in share improvement are extrapolated over 10 years. For a more conservative estimate than Scenario 1, share capture is forecasted in West Secondary at 50% of PSA share capture, and about 33% of PSA East of the CT River and in the Route 9 corridor (except Med and OB).

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Forecasted 10 year Bed Need

With these assumptions, 79 additional beds are required.

SERVICE LINE2004 JDH

Disch.

JDH 2004 Market

Share %

2014 JDH

Disch.

JDH 2014

Market Share

2014 JDH Med-Surg Days

2014 Med-Surg Beds

2014 JDH ICU

Days

2014 ICU

Beds

2014 Total

Beds (Net NICU)

CANCER 492 3.4% 1,066 6.8% 4,927 18.0 115 0.4 18CARDIOLOGY 1,434 2.1% 4,949 4.3% 1,879 6.9 5,603 20.5 27MEDICINE 2,370 1.8% 4,344 3.1% 18,861 68.9 1,853 6.8 76MUSCULOSKELETAL 1,324 3.8% 2,058 5.6% 5,722 20.9 340 1.2 22OBSTETRICS 810 1.8% 1,505 3.0% 7,303 26.7 18 0.1 27PSYCHIATRY 1,034 3.9% 1,097 3.9% 8,922 32.6 9 0.0 33SURGERY 1,240 2.5% 2,228 4.2% 12,035 44.0 1,582 5.8 50GRAND TOTAL 8,704 2.4% 17,248 4.4% 59,649 217.9 9,520 34.8 253

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Scenario 2: Share 2014 Selected Service LinesPSA W Sec E CT Riv Rte 9

Cancer 2004 9.9% 7.7% 4.9% 3.4%Sc 2 2014 23.8% 14.5% 9.8% 8.2%

Cardiology 2004 8.9% 5.0% 1.3% 0.8%Sc 2 2014 13.6% 7.3% 2.7% 2.2%

Musculo-Skeletal 2004 11.7% 13.7% 5.8% 2.0%Sc 2 2014 19.5% 16.9% 8.4% 4.8%

Medicine/Geriatrics 2004 7.5% 2.3% 1.7% 0.6%Sc 2 2014 13.9% 5.4% 1.8% 0.6%

Surgery 2004 8.3% 5.5% 4.0% 1.6%Sc 2 2014 15.5% 9.3% 6.4% 4.0%

Obstetrics 2004 4.4% 6.4% 3.8% 2.1%Sc 2 2014 11.1% 9.5% 3.6% 2.0%

Forecasted share by program and by service area appear to be reasonable, based on recent performance and strategies already in place. These forecasts recognize that cardiology faces continuing stiff competition from other institutions in the PSA, while Cancer is the most distinctive of the service lines. Even with the forecast assumptions, none of the programs will lead the market.

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Additional Scenarios Can be Added

Paula: Additional Scenarios Can be Added

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Ambulatory Requirements• Cancer and Cardiology are the two Signature Programs with hospital-

based ambulatory activity

• Both Cancer and Cardiology will double their market share in the Primary and Secondary Service areas.

• Cancer chemotherapy infusions are likely to be longer in duration in the future, so additional ambulatory infusion capacity may be required. The proposed reconfiguration of ambulatory cancer may be 5,000 SF too little.

• Cardiology procedures will also likely double. Adequate space is allotted for catheterizations and EP procedures with the additional cath lab, but total ambulatory space is too little by about 2,000 SF.

• There will likely be in increase in radiological interventions of all types, as well as increased demand for sophisticated 64-slice CT in cardiology. The radiology area may require additional capacity or an alternative configuration.

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Implementation Plan Elements

• Execute on Signature Program Plans

• Expand current marketing efforts with continued emphasis on Signature Programs.

• Expand physician “detailing” program in Primary and West Secondary, East of CT River, and Route 9 areas.

• Actively encourage community physicians to use John Dempsey Hospital

• Consider modest expansion of primary care physicians.

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Review of Facility Planning Approach

• Confirm Functional Programming Assumptions

• Confirm Space Planning Assumptions

• Assess Existing Infrastructure (High Level)

• Review Schematic Cost Estimates

• Challenge Facilities Solutions

36


Functional Programming Assumptions

• We have reviewed the earlier assessments and studies regarding program growth and corresponding functional assumptions and are in general agreement with those findings

• Other Comments:– Cancer Center lacks coordination and connections with Radiation

Oncology; renovated area in C Building does not meet projected growth for Cancer Services

– Cardiovascular Services are restricted and space available does not meet projected growth needs

– Step down unit will need to be relocated – Surgical Services are physically distant from any SICU beds– SICU and MICU beds should be physically separated– Increasing volumes in Emergency Medicine suggest separate ambulance

and walk-in entrances as well as dedicated and convenient parking– Radiology Master Plan unclear for interventional radiology. UCHC

consider minimizing renovation of existing, consider more friendly program and adjacency for Women’s Imaging

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Space Planning Assumptions

• We have reviewed the earlier assessments and studies regarding program growth and corresponding space planning assumptions and are in general agreement with those findings

• Other Comments:– Increasing lengths of cancer infusion suggest more treatment bays may

be needed in future; assumptions should be reviewed– ORs should be sized at 800 NSF to accommodate the increasing

proliferation of equipment for minimally invasive and robotic procedures. Surgical departments should be planned at 3500 DGSF/OR including area for central sterile supplies

– Nursing units with all private patient rooms sized to accommodate family areas and intensive care technology should be planned at 800 DGSF/bed

– Radiology, 3T MRI should be located to allow easy access / replacement from exterior

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Facilities Solutions – Guiding Principles

• Response to Signature Services Priorities

• Return on Investment

• Enhance Patient Safety and Environment of Care

• Economy/ Value

• Infrastructural Renewal

• Provide Long Term Flexibility

• Enhance image and physical environment of campus

• Investment must meet Signature Program space and technology requirements as major priority

• Investment must yield enough incremental net income to support investment and achieve positive margin

• Renovations and new construction must meet current code requirements. IT investments should move to paperless environment to promote safety.

• Most of investment should be directed toward new and attractive construction

• Infrastructure deficits must be addressed

• Any new construction should allow for additions in the future and ability to change the use of facilities

• New construction should harmonize with existing facilities and improve the overall environment

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Next Session

• Review of Facilities Requirements

• Review Approaches to Renovation and Construction

• Review of Estimated Project Costs

UCHC Facility Review Project Strategic Facilities Planning Working Group Briefing: Revised Forecast...

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