St. Luke's Hospital Report to the Community 2011

Report to the Community:

stlukescr.org

Pioneering better healthcare for all St. Luke’s, in its association as a senior member of the Iowa Health System (IHS), is blazing trails for other hospitals to emulate. As the nation’s highest court weighs in on healthcare reform St. Luke’s and IHS are poised for the inevitable – a new kind of healthcare. The Iowa Health System is a leader in pioneering this new direction.

Our Fort Dodge affiliate was chosen in a competitive selection process as one of only 32 Pioneer Accountable Care Organization’s (ACOs) in the nation.

St. Luke’s recognized as a Top 100 Hospital for the fourth time

the healthcare culture of more is always better. It’s something we have been working towards for some time.

This is evidenced in the fact that we are a four-time winner of Thomson Reuter’s Top 100 Hospital Award. St. Luke’s has St. Luke’s Hospital is one of only two hospitals in the state created a culture where the importance of named one of the nation’s 100 Top Hospitals by Thomson better primary care is stressed, because Reuters, the nation’s leading source of healthcare information.

Ted Townsend we know the integration of physician and The award recognizes hospitals that have achieved excellence President and CEO model hospital services and relentless quality Here in Cedar Rapids, St. Luke’s will be part of an ACO in quality of care, operational efficiency, financial performance and growth. This is the fourth time St. Luke’s has received this for Medicare patients and will also introduce these concepts benchmarking are hallmarks of our future. through a new collaboration distinction. According to Thomson Reuters, it is difficult to be For patients this means that for the first time ever their primary with Wellmark, our state’s selected as a national benchmark hospital every year. Research care doctor will have more detailed information about the care largest private insurer. has shown hospitals that win this award three or more times they have received from other providers. We will see more We can all expect these have particularly high levels of performance over many years. proactive management of chronic conditions to improve healthcare changes in outcomes and reduce hospital admissions or complications. the years to come. It’s The 100 Top Hospitals National Benchmarks study evaluated nearly 3,000 acute care, non-federal hospitals, including driven by new models We will also see an emphasis on staying healthy with proacSt. Luke’s, in 10 areas: mortality, medical complications, of care that move away patient safety, average length of stay, expenses, profitability, tive encouragement for patients to obtain regular exams, from paying more for patient satisfaction, adherence to clinical standards of care, the volume of services immunizations and preventive programs. It’s a system where and post-discharge mortality and readmission rates for rather than focusing doctors lead not only in the care of patients with acute and acute heart attacks, heart failure and pneumonia. The study chronic illness but also patients who are perfectly well and on the quality of has been conducted annually since 1993. The study then a patient’s care. just need the tools to stay that way. compared St. Luke’s performance against similarly sized At St. Luke’s hospitals across the country. this isn’t a new Under the ACO structure hospitals and insurers will share concept. We accountability for ensuring the care provided is both appropriThe study found if all Medicare inpatients throughout the ate and cost effective. Think about it – your doctor and insurer know it is country received the same level of care as those treated in all on the same team, trying to do a better job. This change essential for these 100 Top Hospitals award winners, including represents a transformation of healthcare from a system that changing St. Luke’s, then: has emphasized quantity of care to one that rewards quality • More than 186,000 additional lives could be saved. of care and aims to create a patient experience less confusing • Approximately 56,000 additional patients could be and more comforting. That will be good for all of us.

complication-free.

• More than $4.3 billion could be saved.

• The average patient stay would decrease by nearly half a day.

Sincerely,

Donald Paynter, MD, FACP Internists, P.C. Pulmonary Medicine

Hospitals do not apply, pay for, or complete a survey to receive this designation.

Ted Townsend President and CEO

Caring for our community Community benefits are programs or activities that provide treatment or promote health and healing as a response to identified community needs. The goal is to improve residents’ access to healthcare, enhance the health of the community, advance medical or health knowledge or relieve the burden on government or other community efforts.

St. Luke’s community benefits include education, charity care, subsidized health services, community health improvement activities and more. Here’s a look at a few community programs St. Luke’s offers to make Cedar Rapids a healthier community.

Help for the uninsured St. Luke’s Cook Cancer Wellness Program With progress in diagnosing certain cancers at an earlier stage and improvements in treatment, the number of individuals who refer to themselves as cancer survivors continues to climb.

These survivors need additional services to help them tackle treatment-related side effects and adjust to a new personal health altered by a diagnosis of cancer.

In response to these needs, St. Luke’s Hospital launched the Cook Cancer Wellness Program in 2009. It provides multiple services to cancer survivors and addresses quality-of-life issues in an individualized way.

The program is free to patients and doesn’t end when the patient stops treatment. It’s intended to be available to individuals for as long as they need it – even if that means years after their last treatment.

Services offered through St. Luke’s Cook Cancer Wellness Program include: a program coordinator to help survivors identify needs post cancer, an exercise specialist who works with individuals to devise an exercise and wellness plan, a dietitian to assist patients and survivors with choosing healthy foods, cancer wellness massage for patients and survivors dealing with prolonged pain from treatment and a risk assessment advisor to work with individuals to determine additional cancer risks.

Monetary value Wellness coordinator $ 52,161 Exercise specialist $ 91,282 Dietitian $ 2,340 Wellness massage $ 4,059 Cancer risk assessment $101,654 TOTAL

People served 250 150 52 120 174

$251,496 in FREE cancer support services to the community

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St. Luke’s provides financial assistance to underinsured and uninsured patients. The amount of assistance provided is determined by a patient’s financial need.

Besides providing charity care St. Luke’s works with the Cedar Rapids free clinics to provide support and services to uninsured and underinsured individuals in our community. Last year St. Luke’s provided over $760,000 in services such as X-rays and electrocardiograms (EKGs) to the Community Health Free Clinic (CHFC). This Cedar Rapids clinic provides free medical, dental and prescription services to more than 11,500 individuals annually.

The services that St. Luke’s provides helps Clinic doctors determine the patient’s correct diagnosis and treatment. With 94 percent of Clinic patients reporting household incomes at or below 50 percent of the poverty level, the cost of these services exceeds their means.

“Some of the testing St Luke’s provided has literally saved lives of Clinic patients,” said Darlene Schmidt, CHFC executive director and CEO. “One of our patients, Betty, was diagnosed with diabetes after receiving testing at St. Luke’s. She now has a treatment plan and is successfully managing her diabetes.

Another patient, Bob, received an X-ray to determine if he had gallstones. Today, Bob is recovering following surgery. Without St. Luke’s willingness to partner with Community Health Free Clinic, these outcomes would not be as positive.”

According to Schmidt, St. Luke’s is one of the clinics largest community partners. In addition to the in-kind services, St. Luke’s employees donate their time and talents enabling the Clinic to provide $11 of free healthcare services for every dollar spent. With St. Luke’s support, CHFC is able to assist the uninsured and under-served with free healthcare that improves the quality of life for the patients, their families and our community.

Community benefit value: $762,667

Training tomorrow’s nurses The projected nursing shortage in the United States is expected to intensify as baby boomers age and the need for healthcare grows.

Helping prepare future healthcare professionals is something St. Luke’s takes very seriously. Year round, the hospital supports education for medical and nursing students and technicians.

Last year, St. Luke’s nurses mentored 138 nursing students from five area colleges and universities. St. Luke’s nurses dedicated over 17,000 hours of training. These students learn from experienced professionals how to assess patients, administer medication, evaluate treatment and provide educational and emotional support.

These students may spend anywhere from 12 to 365 hours of intense learning at St. Luke’s per semester with an experienced nurse.

“We teach students how to think like a nurse,” said Joanie Copper, St. Luke’s practice development coordinator. “We have intelligent, compassionate nurses at St. Luke’s who are committed

to teaching future generations of nurses to have those same qualities. We want them to think about how they will improve the patient care they will deliver in the years to come.”

Students trained: Training hours by St. Luke’s nurses: Community benefit value:

138 17,064 $1,151,690 5/2/2012 1:31:52 PM

2011 Quality outcomes Reducing avoidable readmissions

Physical therapy patients report greater improvements

According to the Institute for Healthcare Improvement hospitalizations account for nearly one-third of the total $2 trillion spent on healthcare in the United States. In most of these cases, hospitalization is necessary and appropriate. However, a substantial fraction of all hospitalizations are patients returning to the hospital soon after their previous stay. These rehospitalizations are costly, potentially harmful and often avoidable.

Physical therapy (PT) is a treatment individuals may need after an injury or surgery. PT's goal is to help a patient move better, relieve pain and restore physical function.

As part of St. Luke’s ongoing work to prevent patients from returning the hospital launched a program called Transitions Home in 2006. This program aims to create an ideal transition home or to the next level of care for patients discharged from medical and surgical units at St. Luke’s.

30

15 10 5

Lower is better

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

0 Heart attack

Heart failure

 St. Luke's

Pneumonia

 US national rate

The graph shows how often patients are readmitted within 30 days of discharge from a previous hospital stay for heart attack, heart failure or pneumonia. They may have been readmitted for the same condition as their recent hospital stay or for a different reason.

88 87 86 85 84 83 82 81 80

__________________________________________________________ __________________________________________________________ Higher is better __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ Q2 2010

Q3 2010

 St. Luke's Press Ganey data

Q4 2010

Q1 2011

Q2 2011

Q3 2011

70 60 50 40 30 20 10

Higher is better _________________________________________________________________________ _________________________________________________________________________  



_________________________________________________________________________

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

Q4 2011

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

0

Decreased pain

Greater motion  2009

 2010 Accelero Health Average

 2010

Improved function  2011

 2010 Accelero performers in top 20 percent

When it comes to satisfied patients, look no further than St. Luke’s Emergency Room (ER). Survey results from healthcare research and consulting firm Press Ganey place St. Luke’s ER near the top in the nation when it comes to patient satisfaction.

Patients receive a survey after a visit to St. Luke’s ER. In the survey patients are asked about their experiences during treatment. They evaluate the hospital on a number of factors such as wait time, courtesy of staff, employee responsiveness and attention to detail, facility cleanliness and more. Individuals who completed the questionnaire gave St. Luke’s high marks in virtually every area on the survey.

“High patient-satisfaction scores show our ER employees give a consistently high performance in the treatment of patients,” said Sandi McIntosh, St. Luke’s Emergency Services director. “This is a constant work in progress. We are always fine-tuning the processes and looking for ways to improve our care and have patients seen as quickly and efficiently as possible.”

Recent efforts to improve St. Luke’s ER include a major renovation and expansion, adding guest relations employees to communicate with patients about wait times or other issues and a posted list of expected wait times for tests and procedures like X-rays, CT scans and blood work.

 ER's mean score for 40K visits

2011 Financial overview St. Luke’s Healthcare provided $47



_________________________________________________________________________

Making customer satisfaction a priority

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89

80

Accelero Health Partners data for St. Luke's Therapy Plus from 2009 to 2011.

St. Luke's ER receives top patient satisfaction marks 90

Physical therapy outcomes after orthopedic procedures and injuries 

20



25

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In particular St. Luke’s focused its efforts on heart failure because of its high readmission rate. A team of healthcare providers looked at ways to make the patient’s transition home more family-friendly and identified specific areas that caused a breakdown in communication, which often led to a patient being readmitted to the hospital. Many of the same techniques are now used with other patients who are also at risk for rehospitalizations.

As the chart indicates, St. Luke’s physical therapy patients report decreased pain, greater motion and improved function. St. Luke’s is considered one of Accelero’s top performing hospitals.

Percent improved

2011 readmissions to the hospital within 30 days of discharge

Patients who receive outpatient care at any one of St. Luke’s Therapy Plus’ three locations find their experience satisfying and effective. St. Luke’s works with Accelero Health Partners to identify physical therapy outcomes and compare St. Luke’s patient results with other client results from around the country.

2011 Service record

MILLION

St. Luke’s Hospital

of charity care, community benefit, other uncompensated care and taxes in 2011.

That is 14 percent of St. Luke’s annual expenses.

St. Luke’s is committed to providing the highest level medical care to improve patients’ lives, regardless of their ability to pay. We are focused on strengthening the quality of life and well-being in our communities through sponsorships, in-kind donations, volunteer activities, innovative medicine and unparalleled passion and commitment to our patients. Examples of free services and programs provided include health screenings, support groups, counseling and immunizations.

$46,773,915 in community support Charity care............................................................... $5,520,050 Uncompensated Medicaid ...................................... $10,131,189 Community health improvement services and community benefit operations ......................... $1,594,708 Health professions education .....................................$2,174,831 Subsidized health services......................................... $5,574,947 Cash in-kind contributions to community groups .... $4,738,091 Community building activities ......................................$175,057 Bad debt.....................................................................$3,778,392 Unreimbursed Medicare* ..........................................$1,872,974 Income, property, payroll and sales taxes .................$11,213,676 Total community support .................................. $46,773,915

Health professions education

Unreimbursed Medicare

Bad debt Income, property, payroll and sales taxes

Charity care

Cash in-kind contributions to community groups

Subsidized health services

Community health improvement services & benefit operations

$335,817,000 in operating costs** Salaries & benefits ............................................. $165,520,000 Supplies, implants & pharmaceuticals ................ $55,744,000 Other expenses & purchased services ................. $92,847,000 Depreciation ........................................................ $17,584,000 Interest................................................................... $3,971,000 Provisions for uncollectible accounts*** .................. $151,000

Uncompensated Medicaid

Other expenses & purchased services

Community building activities

Depreciation

Supplies, implants & pharmaceuticals

Care Facilities

Salaries & benefits

Interest Provision for uncollectible accounts

$36,585,708 reinvested in the community** Facility renovation/construction in progress

Total reinvestments ..........................................$36,585,708 *2010 data **Operating costs associated with St. Luke's Physicians & Clinics not included. ***Provisions for uncollectible accounts are expenses incurred when a patient is unwilling to pay. Due to an accounting method change in 2011 the majority of bad debt is netted against gross patient revenue. Total bad debt (at charges) were $11,587,000.

St. Luke’s Physicians & Clinics Patient visits .................................... 330,687

Total operating costs .....................................$335,817,000

Facility renovation/construction in progress ......... $13,810,739 New services/equipment/clinical improvement ...... $8,048,719 IT investment....................................................... $14,726,250

Admissions........................................ 18,947 ER visits ............................................ 55,079 Employees........................................... 3,093 Surgeries ........................................... 23,381 Open-heart procedures .......................... 257 Robotic surgeries .................................... 625 Cardiac Rehabilitation visits .............. 13,186 Heart catheterizations.......................... 1,368 Electrophysiology lab procedures ........ 1,925 Behavioral Health admissions.............. 3,222 Births .................................................. 2,612 Newborn Intensive Care admissions ...... 252 Lifeguard flights ..................................... 276 Family Health Center visits ................. 7,268 Dental Health Center visits.................. 4,428 Diabetes Education visits..................... 8,073 Physical Medicine & Rehab outpatient visits ................................. 54,469 Volunteer hours............................... 109,417 Auxiliary members ................................. 434

Living Center admissions ....................... 248

Jones Regional Medical Center Admissions............................................. 612 Outpatient visits ................................ 55,536

New services/ equipment/clinical improvement

IT investments

Continuing Care Hospital at St. Luke’s (LTACH) Admissions ............................................172

St. Luke’s Hospital Administration Ted Townsend, President & Chief Executive Officer John Sheehan, Executive Vice President & Chief Operating Officer

Michelle Niermann, Vice President, Operations Mary Ann Osborn, Vice President, Chief Clinical Officer

Milt Aunan Vice President, Chief Financial Officer

St. Luke’s Hospital | 1026 A Ave NE, Cedar Rapids, IA 52406 | 319/369-7211 | stlukescr.org AnnualReport-StandAlone-2011.indd 2

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