Improving Medical Acuity and Financial Viability Through Telemedicine

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1 Improving Medical Acuity and Financial Viability Through Telemedicine James K. Gude, MD Clinical Professor of Medicine University of California San Francisco

2 Increased Inpatient Revenues at OffSiteCare Client Hospitals

3 Palm Drive Hospital Returning to Profitability PALM DRIVE HOSPITAL ICU ANALYSIS Fiscal Year 2007* Before OSC (LOS under 4 days) Fiscal Year 2008** With OSC Difference Patient Days Revenues $ 2.36 M $ 15.6 MM $ MM Net Revenues $ 1.5 MM $ 5.2 MM $ 3.7 MM Expenses $ 2.5 MM $ 4.5 MM $ 2.0 MM Estimated Net Loss/Gain - $ 1.02 MM $ 747 K $ 1.77 MM *Fiscal year data; **13-month data

4 Financial Impact: Increased Net Revenues at PDH

5 ICU Length of Stay (days) PDH ICU Increased Patient Retention Palm Drive Hospital - Acute Diagnoses Length of Stay in the ICU Acute Liver Failure w/ Hepatic Enceph Acute Renal Failure Acute Respiratory Failure Pneumonia Septicemia/Sepsis 32% LOS increase for Acute Liver Failure patients 420% LOS increase for Acute Renal Failure patients 83% LOS increase for Respiratory Failure patients 29% LOS increase for Pneumonia patients 26% LOS increase for Septicemia/Sepsis patients

6 % of group transferred Decreased Transfers at Palm Drive Hospital Palm Drive Hospital - Acute Diagnoses Necessity of Transfer % 100.0% 100% % 60.0% 40.0% 20.0% 18% 5% 13% 29% 16% 24% 6% 30% 20% 0.0% Acute Liver Failure w/ Hepatic Enceph Acute Renal Failure Acute Respiratory Failure Pneumonia Septicemia/Sepsis 72% Transfer Rate Reduction from PDH for Acute Liver Failure patients 87% Transfer Rate Reduction from PDH for Acute Renal Failure patients 45% Transfer Rate Reduction from PDH for Respiratory Failure patients 75% Transfer Rate Reduction from PDH for Pneumonia patients 33% Transfer Rate Reduction from PDH for Septicemia/Sepsis patients

7 Increased Service Involvement at PDH:

8 # of patients Service Availability at PDH: Palm Drive Hospital - Number of consultations per service Psych Pediatrics Orthopedics Oncology Nephrology Infectious Disease Gastroenterology Cardiology Psychology/Psychiatry consults were made available to 10% of ICU patients, a 500% increase Orthopedic consults were made available to 9% of patients, a 28% increase Infectious Disease consults were made available to 17% of patients, a 200% increase GI consults were made available to 6% of patients, a 300% increase Pediatric Critical Care, Oncology, and Nephrology services were introduced to PDH via telemedicine by OffSiteCare

9 Howard Memorial Hospital Willits, CA 20% Increase in Total Gross Revenues HOWARD MEMORIAL HOSPITAL ICU & ER ANALYSIS Fiscal Year 2006 Before OffSiteCare Fiscal Year 2008 With OffSiteCare Difference EXPENSES: Robot - $ 56 K $ 56 K Coverage - $ 130 K $ 130 K Director Fees - $ 60 K $ 60 K Total Costs for OffSiteCare Services Total Hospital Gross Revenues - $ 247 K $ 247 K $ 81.1 MM $ 97.7 MM $16.6 MM

10 Howard Memorial Hospital Willits, CA 24% Increase in ER Transfers 59% Increase in ICU Admissions HMH Total ER Transfers to Higher Level of Care & Total ICU Admissions Before and After OSC (2008) Total ER Transfers to Higher Level of Care 1 2 Total ICU Admissions

11 Howard Memorial Hospital Willits, CA 10% Increase in Acuity Scores No Significant Change in Mortality Rates HMH Hospital Acuity Scores Before and After OSC (2008) HMH Risk-Adjusted Hospital Mortality Rates Before and After OSC (2008) HMH Risk-Adjusted ICU Mortality Rates After OSC % 10.00% % 5.00% 0 1 Hospital Acuity Scores* *DRG Method for Analysis 0.00% Hospital 1 Mortality Rates 0.00% ICU Mortality Rates

12 Howard Memorial Hospital Willits, CA Enhanced Satisfaction for Physicians, Nurses, and Patients HMH Physician Satisfaction & Patient Satisfaction Rates Before and After OSC (2008) HMH Nursing Turnover & Hospital Total Turnover Rates Before and After OSC (2008) % 80% 60% 40% 20% 0% 1 2 Physician Satisfaction* Patient Satisfaction** *Johns Hopkins Method for Analysis **National Research Center (NRC) Method for Analysis 12% 10% 8% 6% 4% 2% 0% Nursing Turnover 1 2 Hospital Total Turnover

13 OffSiteCare Re-Opens ICU, Finances Improve at Healdsburg District Hospital Introduction of robotic telemedicine enabled the re-opening of the ICU after a seven-year closure. Year-over-year revenues increased 30% from 2007 to 2008.