MILESTONES EST. 1901

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1 MILESTONES EST A N N U A L R E P O R T

2 OUR VISION: Grand Itasca will be a leader in transforming rural health care by achieving the highest levels of quality, access, and value. OUR MISSION: Patient-Centered Excellence VALUES: Integrity Collaboration Excellence Innovation Service

A Year of Milestones Thanks to the support of our community, 2011 was a year of growth and accomplishment for Grand Itasca Clinic and Hospital.

organization. This past year brought about many new partnerships, including a partnership with Orthopaedic Associates of Duluth to expand our orthopedic services.

Finally, Grand Itasca has worked hard to improve our patients experience and satisfaction by implementing changes in phone messaging, prescription refills, and billing.

Sincerely, To improve patient access to care and increase specialty care offerings, Grand Itasca also added five new care providers in 2011.

3 A Year of Milestones Thanks to the support of our community, 2011 was a year of growth and accomplishment for Grand Itasca Clinic and Hospital. From increases in patient volumes, improved patient satisfaction, and recognized improvements in patient safety and quality outcomes, we saw success throughout our organization. This past year brought about many new partnerships, including a partnership with Orthopaedic Associates of Duluth to expand our orthopedic services. In addition, imaging and pulmonary/sleep services were also expanded through collaborations with local and regional organizations. Finally, Grand Itasca has worked hard to improve our patients experience and satisfaction by implementing changes in phone messaging, prescription refills, and billing. We, the Community Board of Directors, would like to thank you and your family for continuing to entrust your health care to us, and look forward to caring for you in 2012! Sincerely, To improve patient access to care and increase specialty care offerings, Grand Itasca also added five new care providers in These members of our team represent an array of specialties including pathology, emergency medicine, family medicine, anesthesiology and plastic and reconstructive surgery. Mike Youso President and CEO Peter McDermott Chairman We're looking forward to caring for you. M I L E S T O N E 3

[ STATISTICAL HIGHLIGHTS 2010-2011 ] 2010 2011 PATIENT VISITS 14,728 ED Visits 15,020 Day Surgery Out-Patient Imaging PATIENT VISITS 2,165 2,313 Discharges 2,411 33,973 Births 2,392 305 37,776 Clinic

4 [ STATISTICAL HIGHLIGHTS ] PATIENT VISITS 14,728 ED Visits 15,020 Day Surgery Out-Patient Imaging PATIENT VISITS 2,165 2,313 Discharges 2,411 33,973 Births 2, ,776 Clinic Appointments ,488 90,007 In-Patient Imaging 2,486 2,234 Patient satisfaction has improved vastly in 2011, largely because Grand Itasca created a group of dedicated phone nurses in September of 2010 giving patients direct access to nurses and a faster response time.

5 Patient Satisfaction: Achievements in Responsiveness Providing the best possible patient experience is a priority at Grand Itasca. Our greatest source of feedback comes from our satisfaction surveys. Applying what we learn from them helps us improve our processes as well as our patients experiences. We ve seen our patient satisfaction score for promptness double over the course of the year, rising from the 29th percentile in October 2010 to the 58th percentile by the fourth quarter of 2011, said Gustafson. Along with happier patients, we now have more satisfied providers and nurses as well. One of the biggest issues for both patients and their healthcare providers was the way that phone calls were handled, said Christy Gustafson, RN, BSN and Director of Clinic Operations at Grand Itasca. In the third quarter of 2010, Grand Itasca ranked in just the 29th percentile among all clinics in promptness in returning phone calls. After studying the current process and getting input from providers, nurses and switchboard staff, a group of dedicated phone nurses was created in September The phone nurses primary responsibility is to answer phone calls. Now when a patient calls, they are able to speak to a phone nurse who can assist them in a more direct manner. Even when volume is heavy and calls cannot be answered immediately, the vast majority are returned within 20 minutes. Congratulations to our Intensive Care Unit and Emergency Room staff for increased patient satisfaction scores. ER had their highest ranking in 3 years with scores in the 85th percentile! Additional Milestones In addition to phone communications, Grand Itasca also looked at its billing and prescription refill process. In other departments, improvement took the form of a shift in culture. Culture is a blend of attitudes, actions and beliefs, and it greatly influences the way in which staff interacts with and responds to patients. Making changes in the way they relate to and care for patients, Surgical Services staff at Grand Itasca has seen its patient satisfaction score go from the 62nd percentile in early 2011 to the 95th percentile by the fourth quarter of The surgical staff has worked diligently to improve the patient experience. The staff has felt really empowered to do what they need to do to provide the best possible care for our patients, said Gloria Holcomb, Director of Quality/Risk Management. All of the OR and Day Surgery nursing and support teams have taken great pride and ownership in improving patient satisfaction. M I L E S T O N E 5

Stroke Cardiovascular Services Service Partnership Allina Health Electronic Health Record (EPIC) Center for Diagnostic Imaging GRAND ITASCA Clinic & Hospital Orthopaedic Associates Sports Medicine

6 Stroke Cardiovascular Services Service Partnership Allina Health Electronic Health Record (EPIC) Center for Diagnostic Imaging GRAND ITASCA Clinic & Hospital Orthopaedic Associates Sports Medicine CDI-Grand Rapids ENT Orthopedic Surgery Deer River Healthcare Radiological Associates of Duluth Fairview Range Pulmonary/ Sleep Study Through an additional partnership with Fairview Range - Hibbing, Grand Itasca was able to expand Pulmonary and Sleep Medicine services through the joint hiring of a Pulmonologist.

7 New Partnerships: Achievements in Access Grand Itasca started the 2011 New Year by launching a partnership with Orthopaedic Associates of Duluth. This alliance brings the Grand Rapids community the best of both worlds: specialty orthopedic care within a full-service hospital and clinic, where patients can easily communicate and connect with their primary care physician. Another new venture is CDI-Grand Rapids, a medical imaging and pain management alliance between Grand Itasca Clinic & Hospital, Deer River HealthCare Center, the Center for Diagnostic Imaging (CDI) and Radiological Associates of Duluth. This 4-way partnership centralizes local Medical Resonance Imaging (MRI) and pain management services under one entity. Grand Itasca Clinic & Hospital has a long history with Orthopaedic Associates, said Nathan Noznesky, M.D. and Chief Medical Officer. By partnering directly with our colleagues at Orthopaedic Associates and expanding our services, we are able to provide our community with greater access to high-quality orthopedic care. We re very pleased. By partnering directly with our colleagues at Orthopedic Associates we are able to provide our community with greater access to high-quality orthopedic care. Nathan Noznesky, MD Chief Medical Officer As part of the agreement, CDI-Grand Rapids will provide diagnostic injections and pain management services as well as manage the high-field MRI scanner at Grand Itasca Clinic & Hospital. In addition, CDI-Grand Rapids will install and manage a new high-field, opensided MRI scanner at Deer River Healthcare Center in the spring of 2012, replacing the existing mobile MRI service in our area. In mid-2011, the decision was made to implement Epic throughout Grand Itasca. Epic is the industry leader in electronic health record management systems in Minnesota and the United States. A partnership was formed with Allina Health to support and assist Grand Itasca with the implementation and ongoing operational support of Epic. Grand Itasca CEO Michael Youso summarized the benefits: These partnerships are an opportunity to expand services, improve access and share resources through collaboration with local and regional healthcare providers. Grand Itasca Surgical Services saw an 11% increase in cases from 2010 in large part because of our partnership with Orthopaedic Associates. M I L E S T O N E 7

8 UNCOMPENSATED CARE Core Measures have been shown to reduce the risk of complications, prevent recurrences and help hospitals deliver better care by focusing on the patient's results.

9 Core Measures: Achievements in Quality At Grand Itasca, we consistently strive to deliver the highest quality of care to our patients. One example is following a set of care processes called Core Measures. Developed by the Joint Commission, the nation s largest health care standard-setting and accrediting body, Core Measures are designed to improve the quality of health care through a national, standardized performance measurement system. Core Measures have been shown to reduce the risk of complications, prevent recurrences and help hospitals deliver better care by focusing on the patient's results. The program consists of 33 measures across 4 categories: acute myocardial infarction (AMI), community-acquired pneumonia, congestive heart failure, and surgical care improvement project (SCIP). Each measure provides guidelines for delivering excellent patient care, and include specifics for best practices the most widely accepted, research-based processes for appropriate care. These results stem from physician leaders and department leaders working together to design care processes that enable us to provide the right care for the right patient, every time. In 2011, Grand Itasca reached its target for all Perfect Care Composite scores for Inpatient Heart Failure, AMI, Pneumonia and SCIP as well as Outpatient Gloria Holcomb Director of Quality/Risk Management AMI, Chest Pain and SCIP. Gloria Holcomb, Director of Quality/Risk Management stated, These results stem from physician leaders and department leaders working together to design care processes that enable us to provide the right care for the right patient, every time. Ranked among the best, Grand Itasca achieved 100% in AMI, SCIP, Outpatient Chest Pain, and Outpatient SCIP scores in M I L E S T O N E 9

10 Fiscal Year 2011 Statement of Operations* A Year of Financial Progress 2011 was a strong year for Grand Itasca financially. For the first time since 2007, Grand Itasca experienced a full 12-month year with an operating income. These positive results were driven in part by the higher patient volumes across the whole organization. Consolidated Statement of Financial Position in Thousands assets Total Current Assets Noncurrent Cash and Investments Capital Assets, Net FY 2010 $ 20,337 19,207 49,999 FY 2011 $ 27,055 19,675 45,099 Total 89,543 91,829 liabilities and net assets Total Current Liabilities Long-term Debt, Net Total Net Assets 8,183 45,441 36,919 89,543 8,604 43,801 39,424 91,829 Operating Revenue Operating Room 10.7% consolidated statement of activities Total Operating Revenue Total Operating Expenses Operating Income 67,283 68,670 (1,388) 75,016 73,574 1,442 Emergency Room 11.4% Diagnostic Services 14.2% Pharmacy 2.6% Non Operating Revenue and Expenses Net Assets Released from Restriction Change in Net Assets 576 (752) (60) ,595 Inpatient 12.5% Clinic 48.6% M I L E S T O N E 1 0

11 operating revenue Inpatient Clinic Operating Room Emergency Room Diagnostic Services Pharmacy FY 2010 $ 13,746 67,033 13,905 13,945 17,841 3,630 FY 2011 $ 18,461 71,672 15,753 16,874 20,886 3,823 Total 130, ,467 Contractual Adjustments and Discounts Community Care Net Revenue (62,936) (458) 66,705 (72,150) (301) 75,016 Operating Expenditures Fees & Purchased Services 4.9% operating expenditures Wages and Benefits Fees and Purchased Services Supplies and Other Expenses Utilities and Maintenance Depreciation Interest Bad Debt 41,650 3,475 10,849 2,797 4,864 2,457 2,287 43,272 3,620 13,004 2,730 5,359 2,174 3,415 Supplies & Other Expenses 17.7% Utilities & Maintenance 3.7% Depreciation 7.3% Interest 3% Bad Debt 4.6% Total 69,239 73,574 Wages & Benefits 58.8% * In 2011 Grand Itasca switched from a fiscal year that ended in June to a calendar fiscal year. M I L E S T O N E 1 1

12 Foundation Update Achievements in Philanthropy Philanthropy is vital to Grand Itasca s ability to maintain its role as a health care leader. Grand Itasca Foundation makes a difference in health care for our community. We sincerely appreciate the important role you play in helping make that difference. Capital Campaign Projects Funded in 2011: $42,850 BladderScan BVI 9400 Instrument for the Emergency Department and Intensive Care Unit: $16,283 Dexcom Wireless Continuous Glucose Monitoring System for the Diabetic Education Department: $1,170 Non-Invasive Ventilator Machine: $13,068 Heated, Reclining Patient Chairs for the Infusion Center: $7,329 Recycling Program Initiative at Grand Itasca: $5,000 Grand Itasca Foundation Grants Awarded in 2011: $11,388 Baby Steps Boutique child and parent educational classes: $2,500 ElderCircle BoneBuilders Program new class site: $2,870 Itasca Community College Medical Ethics Seminar: $1,500 Women and Girls Wellness and Lifestyle Expo: $1,500 Coronary Health Improvement Project (CHIP): $1,200 ElderCircle Senior Wheels Program: $1,500 Nutrition Nuggets Newsletter: $318 Grand Itasca Foundation Scholarship Recipients in 2011: $8,500 Dr. and Mrs. Robert Kelly Scholarship: $2,000 Awarded to Willow Loney and Derek Flier Deb Shrout Memorial Award: $500 Awarded to Lisa Grossman High School Health Care Scholarships: $6,000 Awarded to Jill LaBine, Abby Margo, Eric Stefanich and Laurel Wright In 2011, Grand Itasca Foundation launched an employee giving campaign that raised over $12,000 to support technology and facility enhancements at Grand Itasca along with Care to Share a crisis fund to assist Grand Itasca employees in a time of need. M I L E S T O N E 1 2

GRAND ITASCA BOARD OF DIRECTORS Peter McDermott Chair Marva Jean Hutchens Vice-Chair Mary Kosak Secretary Shelly Steere Treasurer Jamison Harker, MD Richard Helvig, MD Ron Iannelli Mike Ives Charles

Officer GRAND ITASCA FOUNDATION BOARD OF DIRECTORS Barb Arbour Chair Dale Adams Vice-Chair Sandy Harling Secretary Diane Weber Treasurer Gwynne Bobich Patty Carlin-Janssen, MD Kathy Fauth Christy

14 GRAND ITASCA BOARD OF DIRECTORS Peter McDermott Chair Marva Jean Hutchens Vice-Chair Mary Kosak Secretary Shelly Steere Treasurer Jamison Harker, MD Richard Helvig, MD Ron Iannelli Mike Ives Charles Kampen, MD Barbara McDonald Elizabeth Miskovich Colleen Nardone Jan Rourk, MD Barb Sanderson GRAND ITASCA EXECUTIVE OFFICERS Mike Youso Chief Executive Officer Nathan Noznesky, MD Chief Medical Officer GRAND ITASCA FOUNDATION BOARD OF DIRECTORS Barb Arbour Chair Dale Adams Vice-Chair Sandy Harling Secretary Diane Weber Treasurer Gwynne Bobich Patty Carlin-Janssen, MD Kathy Fauth Christy Gustafson, RN Cricket Guyer Ron Johnson, MD Hans Kaldahl, DVM Tina Kane Donna Kelly Tara Makinen Judy Pittack Steve Wright GRAND ITASCA FOUNDATION EXECUTIVE OFFICER Kelly Kirwin Foundation Director A special thanks in honor and memory of Dale E. Blank, Foundation Board Member, M I L E S T O N E 1 4

16 1601 Golf Course Road // Grand Rapids, MN

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