Big Sky Medical Center

Serving the Communities of Central & South Gallatin County

Presented by:
Bozeman Deaconess Health Services July 24, 2013

To view this presentation and find more information about our Big Sky Medical Center 

www.bigskymedicalcenter.com www.bozemandeaconess.com
Click on Big Sky Medical Center icon!

Bozeman Deaconess Health Services

Service Area
Primary Service Area: Gallatin County Secondary Service Area: Park County Madison County Providing Outreach & Resource Support Services to: Livingston Big Sky Manhattan Three Forks Butte Sheridan Ennis Dillon Townsend West Yellowstone Providing essential healthcare services to communities in our service area since 1911.

The Next Century of Commitment, Caring and Service.

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Big Sky Medical Center (BSMC) Plan

New medical facility will be a 35,000 sq. ft. 2-story building.
9 9 9 9

$21 Million Estimated Project Cost 24/7/365 Emergency Services Hospital, Primary Care Clinic, Laboratory, Imaging, Pharmacy Project Budget includes Employee Housing component

Facility will have on-site local leadership and a local governing board, who will be accountable for clinical excellence, quality, safety and operating performance.

Facility will initially add over 30 new jobs in Big Sky.

Bozeman Deaconess Board of Trustees has approved the project and its related funding.

We are ready to go!

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Big Sky Medical Center - Financing Plan

BDHS will responsible for all financing and debt service required for construction and operation of the Big Sky Medical Center.

BSMC may, in the future, make application through the annual Resort Tax Board funding process for future capital equipment requests and health services expansion

BDHS will be accountable for the annual financial risk of the new medical center, as a vested partner in the Big Sky community

BDHS is not requesting tax levy support from the Big Sky Resort Tax Board for our facility project to move forward

Big Sky Medical Center Important Role of Philanthropy

Community philanthropic support is important to the long-term success of a not-for-profit organization, including Big Sky Medical Center.

Philanthropy supports:
New facility construction and future expansions New and replacement equipment & technologies Clinical services growth and community programs Charity care and operating endowments

Big Sky Medical Center Foundation Board will be created to lead the philanthropy activities in support of Big Sky Medical Center

A capital fund-raising campaign will be done to provide grateful patients, individuals, families and businesses the opportunity to give tax-deductible gifts to the Big Sky Medical Center project

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Big Sky Medical Center Project Timeline

Site Work Prep Fall 2013 Ground Prep Ground Breaking Spring 2014 Construction & FF&E 12-16 mths Recruit/Hire/Train 6-8 mths in advance Open Fall 2015

Infrastructure

BDHS is ready to begin now and has mobilized its project team

BDHS estimates a 24-month design and construction timeline

Ground-breaking is targeted to occur in Spring 2014

Big Sky Medical Center will be completed & open in Fall 2015
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BIG SKY MEDICAL CENTER

Big Sky Medical Center: Location

Big Sky Medical Center will be constructed on the land BDHS purchased in Big Sky Town Center in 2007

BDHS has secured the required land to accommodate immediate development of our planned Big Sky Medical Center facility, support structures, green space and required parking

Big Sky Medical Center Emergency Services

Key Themes

24/7/365 Emergency Services Coordinated with Big Sky Fire & EMS and Ski Patrols Rooftop heli-stop for air ambulance Staffed by board-certified physicians w/emergency medicine certification Tele-,^> III Trauma Center

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Big Sky Medical Center Hospital Services

New facility would seek Hospital licensing & Critical Access Hospital (CAH) certification Initially a 5-bed unit, with allocated space to increase to 10 beds without additional facility expansion All private patient rooms Inpatient acute care admissions Patients requiring observation Swing Bed Services for skilled nursing care once approved as CAH 24/7 Nursing Coverage

Key Themes

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Key Themes Big Sky Medical Center Outpatient Diagnostic & Treatment Center

On-site Imaging Services General Radiology CT Scanner, Ultrasound Mobile MRI Laboratory services Surgery/Procedure Suite
for minor surgery procedures, diagnostic endoscopy, and trauma treatment

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Big Sky Medical Center Primary Care Clinic

Preventive & continuing care Acute medical needs Sports physicals Electronic Medical Record Patient-Centered Medical Home Alignment with existing Big Sky medical physicians & providers

Key Themes

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Big Sky Medical Center Other Medical Services

Occupational Health Services Integrated pharmacy, with expanded retail coverage Lease space available for other medical and health service providers physical therapy, etc.

Key Themes

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Key Themes

Big Sky Medical Center - Specialty Clinics

Medical & Surgery Specialty Clinics Cardiology, Oncology, GI, Neurology & coordinated access to more than 40 specialties Seattle Cancer Care Alliance consults, clinical trials, access to resources of University of Washington Medicine, Seattle &, Cancer Research Center

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Big Sky Medical Center Connectivity with BDHS

Integrated electronic medical record system with BDHS

Key Themes

Telemedicine, Teleradiology, & Telepharmacy linkages to BDHS specialists

LifeNet Receiving Station Transmits ECG readings while patient is in transit so patient bypasses Bozeman Deaconess ER and goes straight to the Cardiac Cath Lab

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EXPANDING PRIMARY CARE ACCESS IN WEST YELLOWSTONE

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West Yellowstone Current State

Community Health Partners (CHP), a Federally Qualified Health Center (FQHC) currently provides: Primary Care to all local residents, with sliding fee scale available for qualifying patients (60% of current patients) 6 Days/wk during summer season; 4 days/wk other months Nurse visits, behavioral health counseling 1 day/week > Ancillary Diagnostics On-Site: General X-rays, Labs, Drug Testing

Bozeman Deaconess provides the CHP West Yellowstone Clinic: Teleradiology, Lab courier and reference lab services, Electronic Health Record, Furnishings and Equipment, Health Fairs, Community Outreach with free health screenings

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West Yellowstone - Future

Bozeman Deaconess proposal for West Yellowstone is to build on the existing 3-year success of our partnership with the CHP West Yellowstone Clinic
9 Step 1: Secure continued community and City of West Yellowstone financial support for the CHP clinic 9 Step 2: Partner with CHP to add part-time primary care physician coverage in West Yellowstone 9 Step 3: Recruit a full-t Yellowstone, supplemented by continuing advanced practitioner coverage.

^,W&Y, Center certification for West Yellowstone and Big Sky

9 Requires federal government to first designate as a FQHC competitive bid site. 9 Provides direct federal grants to support operations & sliding fee schedule 9 May reduce the requested annual amount of City of Yellowstone funding to support the CHP West Yellowstone Clinic

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Big Sky Medical Center

CORPORATE STRUCTURE & GOVERNANCE

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Big Sky Medical Center - Governance

A new Big Sky-based corporation, Big Sky Health Services- for-(c) (3) corporation

d provide the community and fiduciary oversight of Big Sky Medical Center

The Board of Directors will be also be  service and operating performance.

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Big Sky Medical Center - Governance

Big Sky Health Services Board of Directors will be a 9-member board that will include:
7 Community Members , 2 Members appointed by Bozeman Deaconess Board 1 Bozeman Deaconess Board member President/CEO of BDHS

Big Sky Board Chair will be a voting member of Bozeman Deaconess Board of Trustees

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Corporate Organization

Bozeman Deaconess Health Services

Bozeman Deaconess Foundation Board of Directors

Board of Trustees

Big Sky Health Services

Big Sky Medical Center Foundation Board

Board of Directors

Bozeman Deaconess Hospital

Bozeman Deaconess Real Estate Development Corporation Board of Directors

Hillcrest Senior Living, LLC

Big Sky Medical Center

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Big Sky Medical Center

COMMUNITY PROVIDER RELATIONSHIPS

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Our Commitment to the Big Sky Physicians & Providers

Our relationship with the current Big Sky physicians and providers spans decades & multiple generations of families. We collaborate to co-manage thousands of patients together.

We are committed to alignment and/or integration with the Big Sky physicians & providers and are having on-going, private discussions with each of them regarding those options.

Options include: employment, professional services contracts, joint ventures, medical leadership roles, leasing of space in the new facility, recruitment assistance and others.

Collaborative discussions are ongoing to identify the preferred arrangement with each individual provider. 25

Big Sky Medical Center

COMMITMENT TO SERVING ALL PATIENTS

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Financial Assistance Information: bozemandeaconess.org

1 Click from the Home Page links you to Financial Assistance Information for BDHS

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Financial Assistance Information

At bozemandeaconess.org you will find: Financial Assistance Program Guidelines & Policy Application Forms & Process BDHS accepts sliding scale from Community Health Partners [CHP] clinics we do not make CHP patients re-qualify As a nonprofit hospital, Bozeman Deaconess is committed to providing medically necessary health care to all, regardless of financial ability to pay This policy will extend to the hospital and clinic services of Big Sky Medical Center and West Yellowstone

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BDHS Financial Assistance 2011

6,600 patient accounts received financial assistance 98.5% of those that applied received some level of financial assistance 95 accounts did not receive assistance
93 of those did not complete the process Only 2 accounts in 2011 were denied because they had too many assets to qualify

With an integrated delivery model, we ensure primary care access for all patients Medicare, Medicaid, Insured and Un-Insured/Self Pay.

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Big Sky Medical Center

COMMITMENT TO THE COMMUNITY

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Community Collaboration
For detailed information on Bozeman Deaconess and its Community Benefit Plans and activities, these website resources are as available: www.bozemandeaconess.org/reports Community Benefit Reports 2012 2014 Community Benefit Plan 2011 Bozeman Deaconess Health Services community Health Needs Assessment Summaries and 2012-2014 Implementation Strategy 2011 Community Needs Assessment Report Community Health Newsletters Healthy Gallatin Collaborative Key project partners invested time and resources to improve healthy living: Bozeman Deaconess Health Services, Community Health Partners, Gallatin City- County Health Department, & MSU Extension www.healthygallatin.org

Community Care Connect Mobile Outreach & Screening Bozeman Deaconess offers free health screenings and immunizations to residents throughout the region including West Yellowstone, Big Sky, Manhattan, Three Forks, Gallatin Gateway, shelters, & Gallatin Valley Food Bank locations Partnership with Bozeman Deaconess, Gallatin City County Health Department, Human Resources Development Council (HRDC), and Community Health Partners

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2XU&UHGHQWLDOV
BDHS has served the residents and visitors of Gallatin County for more than 100 years. For decades, our medical staff have been active partners ^tz providers in service to our mutual patients. In response to community need, since 2004 we have operated the Big Sky Pharmacy providing local access to prescription services. We receive recognition and numerous national awards for quality, safety, cost efficiency, and patient experience.

BDHS is consistently ranked as one of the top health systems in Montana, the region and nation
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BDHS Awards and Recognition

"A" Hospital Safety Score (SM) by The Leapfrog Group Bozeman Deaconess Hospital receives HealthGrades KW The Joint Commission Accreditation 5-Star Rating from HealthGrades for Joint Replacement Mountain-Pacific Quality Health Foundation Quality Achievement Award Five-Star Award for Community Value, 2007-2010, 2013 Designated Blue Distinction Center for Knee and Hip Replacement Joint Replacement Excellence Award by HealthGrades First in Montana for NCQA Level III Medical Home Recognition Five-Star Rated for Total Hip Replacement & Total Knee Replacement Overall Orthopedic Services: Top 5 in MT Five-Star Rated for Coronary Interventional Procedures NCQA Diabetes Management Accreditation

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Quality Performance
CMS Website Publically Reported Quality Data
www.medicare.gov/hospitalcompare Note: This i s newer data than what the consultant had i n his report Quality reported data represents a 'snapshot i n time' and i s continually being updated

Summary: 47 measures

BDH scored better on BC scored better on BDH & BC tied on 13 of them; the differences i n most cases are not significant 23 11

There are a number of rating methodologies out there which measure different time frames and slightly different metrics; & the composite of all of them puts us both as very good hospitals. Consumer Reports : (Aug 2012): Ranked by safety Score BDH was 2nd in MT with a score of 63; BC was 4th in MT with a score of 60 Leapfrog Group : 2012: BDH & BC both received "A" ratings in spring and fall (the only two hospitals in MT to achieve this) Value Based Purchasing: CMS FY2013: BDH had highest score of any general hospital in MT Readmission Penalty: neither BDH or BC got a penalty for FY2013
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Quality Performance
CMS Website Publically Reported Quality Data
www.medicare.gov/hospitalcompare Note: This i s newer data than what the consultant had i n his report Quality reported data represents a 'snapshot i n time' and i s continually being updated
Bozeman Deaconess Billings Clinic Comments There are 10 categories - we were rated higher than BC i n 7 of them (including overall rating); tied them i n 2, and were rated l ower than BC i n 1. Out of 10 measures BC scored higher than BDH on only one Out of 17 measures, BDH scored higher (10) or tied (5) on 15 of them; BC scored higher on just 2 2 measures; BDH scored higher on both 3 measures; BDH scored higher on 2; tied on the other 2 measures; tied on 1; BC scored higher on the other 10 measures; BDH scored higher on 6; BC scored higher on 1; tied on 3 others Out of 6 measures, BDH scored higher on 3, tied on 1; BC scored higher on 2 2 measures; BC scored high on both Preventive Care Mortality Heart Attack Heart Failure Pneumonia Surgical Serious Complications Deaths from serious complications Hospital Acquired Infections Hospital Acquired Conditions Medical Imaging Spending per hospital patient Summary: 47 measures Both "no different than the US national rate"; BDH (14.3%); BC (14.6%) Both "no different" BDH (12.6%); BC (12%) Both "no different" BDH (10.7%); BC (13.4%) BDH: "no different than national avg"; BC: better than avg Both "no different than national avg BDH scored better on 2; BC scored better on 1 8 measures. BDH scored better on 1; BC scored better on 2; Tied the rest (5) 5 measures. BDH scored better on 3; tied 1; BC better on 1 BDH (.92); BC (.91) BDH scored better on BC scored better on BDH & BC tied on 13 of them; the differences i n most cases are not significant 23 11

Patient Experience

Overall Rating

Timely & Effective Care Heart Attack Heart Failure Pneumonia Surgical Care

Timely ED Care

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Questions & Comments

www.bigskymedicalcenter.com

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Big Sky Medical Center

COMMUNITY CHOICE VALIDATING THE BDHS PLAN

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,^W^tz Emergency/Trauma Services

61% of residents in Big Sky would choose Bozeman Deaconess for Emergency/Trauma Services, 66% of residents in West Yellowstone would choose Bozeman Deaconess for Emergency/Trauma Services, 21% would prefer to travel out of state

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,^W^tz Heart/Cardiac Care

44% of Big Sky residents would choose Bozeman Deaconess for Heart/Cardiac Care 17% would choose Billings Clinic and 17% would choose St. Vincent Healthcare in Billings.
Bozeman Deaconess provides medical and interventional cardiac care but does not provide open heart surgery. BDHS physicians refer to both Billings hospitals based on patient preference and medical condition

45% of West Yellowstone residents would choose Bozeman Deaconess for Heart/Cardiac Care 41% would choose to travel out of state

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,^W^tz Cancer Treatment

37% of Big Sky residents would choose Bozeman Deaconess for Cancer Treatment. 17% would prefer to travel out of state, compared to 12% who would choose either of the Billings hospitals 45% of residents in West Yellowstone would choose Bozeman Deaconess for Cancer Treatment, 45% would prefer to travel out of state

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,^W^tz Orthopedic Surgery

56% of the Big Sky residents would choose Bozeman Deaconess for Orthopedic Surgery, compared to 7% who would prefer to travel out of state, 7% would travel to Billings Clinic, and 5% would travel to St. Vincent in Billings 55% of residents in West Yellowstone would choose Bozeman Deaconess for Orthopedic Surgery, 31% would prefer to travel out of state

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Big Sky and West Yellowstone Residents who have had to travel more than 100 Miles to receive healthcare
Big Sky (2013)
Within the past five years have you or anyone in your household travelled more than 100 miles to receive healthcare because expertise or treatment were not available locally?

90%

80% 70% 60% 50% 40% 30% 20% 10% 0% no yes

W. Yellowstone (2013)
Within the past five years have you or anyone in your household travelled more than 100 miles to receive healthcare because expertise or treatment were not available locally?

80%

70% 60% 50% 40%

30%

Big Sky 85% of respondents indicated that they have not had to travel past Bozeman to receive healthcare West Yellowstone 24% of respondents indicated that they have not had to travel beyond 100 miles to receive care, and 76% have had to travel beyond that distance.
Ennis = 70 miles Rexburg = 80 miles Bozeman = 90 miles Idaho Falls = 108 miles New BSMC will be 45-50 miles

20% 10% 0% no yes

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Perceived Big Benefit in Big Sky and West Yellowstone for Urgent Care
39% of Big Sky residents indicated the community would receive a big benefit from adding additional urgent care services, compared to 12% in the 2010 survey 34% of West Yellowstone residents indicated the community would receive a big benefit from adding additional urgent care services, compared to 66% in the 2010 survey
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Perceived Big Benefit in Big Sky and West Yellowstone for 24-Hour Emergency Care
44% of Big Sky residents indicated the community would receive a big benefit from adding 24-hr emergency care, compared to 16% in the 2010 survey 38% of West Yellowstone residents indicated the community would receive a big benefit from adding 24-hr emergency care, compared to 66% in the 2010 survey
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W. Yellowstone

Benefit from adding more of this resource to community: 24-hr emergency care
70% 60% 50% 40% 30% 20% 10% 0% 1 (small) 2 3 4 5 6 7 8 9 10 (big) 2013 2010 2008 2006

Perceived Big Benefit in Big Sky and West Yellowstone for Additional primary care providers
24% of Big Sky residents indicated the community would receive a big benefit from adding additional primary care providers, compared to 8% in the 2010 survey. 17% indicated that it would be of small benefit 52% of West Yellowstone residents indicated the community would receive a big benefit from adding additional primary care providers, compared to 71% in the 2010 survey

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Perceived Big Benefit in Big Sky and West Yellowstone for Additional Specialty Providers
29% of Big Sky residents indicated the community would receive a big benefit from adding specialist providers, compared to 10% in the 2010 survey. 15% indicated that it would be of small benefit 17% of West Yellowstone residents indicated the community would receive a big benefit from adding additional specialist providers, compared to 31% in the 2010 survey
9 10 (big)

W. Yellowstone

Benefit from adding more of this resource to community: Additional specialty doctors
50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 1 (small) 2 3 4 5 6 7 8 2013 2010 2008 2006

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Perceived Big Benefit in Big Sky and West Yellowstone for Advanced Medical Imaging
34% of Big Sky residents indicated the community would receive a big benefit from adding additional advanced imaging, compared to 10% in the 2010 survey. 17% of West Yellowstone residents indicated the community would receive a big benefit from adding additional advanced imaging, compared to 40% in the 2010 survey
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