AGENDA SECTION 1. OPENING CEREMONIES CALL TO ORDER. 1. Public Comment

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1 AGENDA University Medical Center of Southern Nevada UMC GOVERNING BOARD STRATEGIC PLANNING COMMITTEE August 9, :00 p.m. 800 Hope Place, Las Vegas, Nevada UMC Trauma Building, ProVidence Suite (5 th Floor) Notice is hereby given that a meeting of the UMC Governing Board Strategic Planning Committee has been called and will be held at the time and location indicated above, to consider the following matters: This meeting has been properly noticed and posted in the following locations: University Medical Center CC Government Center Third Street Building Regional Justice Ctr 1800 W. Charleston Blvd. 500 S. Grand Central Pkwy. 309 S. Third St. 200 Lewis Ave., 1 st Fl Las Vegas, NV Las Vegas, NV Las Vegas, NV Las Vegas, NV (Principal Office) City of Las Vegas City of Henderson 400 Stewart Ave. 240 Water St. Las Vegas, NV Henderson, NV The main agenda is available on University Medical Center of Southern Nevada s website For copies of agenda items and supporting back-up materials, please contact Terra Lovelin, Board Secretary, at (702) The Strategic Planning Committee may combine two or more agenda items for consideration. Items on the agenda may be taken out of order. The Strategic Planning Committee may remove an item from the agenda or delay discussion relating to an item at any time. Consent Agenda - All matters in this sub-category are considered by the Strategic Planning Committee to be routine and may be acted upon in one motion. Most agenda items are phrased for a positive action. However, the Strategic Planning Committee may take other actions such as hold, table, amend, etc. Consent Agenda items are routine and can be taken in one motion unless a Strategic Planning Committee member requests that an item be taken separately. For all items left on the Consent Agenda, the action taken will be staff's recommendation as indicated on the item. Items taken separately from the Consent Agenda by Committee members at the meeting will be heard in order. SECTION 1. OPENING CEREMONIES 1. Public Comment CALL TO ORDER PUBLIC COMMENT. This is a period devoted to comments by the general public about items on this agenda. If you wish to speak to the Committee about items within its jurisdiction but not appearing on this agenda, you must wait until the Comments by the General Public period listed at the end of this agenda. Comments will be limited to three minutes. Please step up to the speaker's podium, clearly state your name and address and please spell your last name for the record. If any member of the Committee wishes to extend the length of a presentation, this will be done by the Chair, or the Committee by majority vote. 1 Page 2 of 33

2 2. Approval of minutes of the regular meeting of the UMC Governing Board Strategic Planning Committee meeting on June 7, (For possible action) 3. Approval of Agenda. (For possible action) SECTION 2. BUSINESS ITEMS 4. Receive a Strategy Committee, Year in Review update; and direct staff accordingly. (For possible action) 5. Receive a report on overall market dynamics related to health care activity; and direct staff according. (For possible action) 6. Receive a report regarding UMC service lines; and direct staff accordingly. (For possible action) 7. Identify emerging issues to be addressed by staff or by the Strategic Planning Committee at future meetings, and direct staff accordingly. (For possible action) SECTION 3. CLOSED SESSION 8. Go into closed session pursuant to NRS (3) to discuss new or material expansion of UMC s health care services and hospital facilities. COMMENTS BY THE GENERAL PUBLIC A period devoted to comments by the general public about matters relevant to the Committee s jurisdiction will be held. No action may be taken on a matter not listed on the posted agenda. Comments will be limited to three minutes. Please step up to the speaker s podium, clearly state your name and address and please spell your last name for the record. All comments by speakers should be relevant to the Committee s action and jurisdiction. UMC ADMINISTRATION KEEPS THE OFFICIAL RECORD OF ALL PROCEEDINGS OF UMC GOVERNING BOARD STRATEGIC PLANNING COMMITTEE. IN ORDER TO MAINTAIN A COMPLETE AND ACCURATE RECORD OF ALL PROCEEDINGS, ANY PHOTOGRAPH, MAP, CHART, OR ANY OTHER DOCUMENT USED IN ANY PRESENTATION TO THE BOARD SHOULD BE SUBMITTED TO UMC ADMINISTRATION. IF MATERIALS ARE TO BE DISTRIBUTED TO THE COMMITTEE, PLEASE PROVIDE SUFFICIENT COPIES FOR DISTRIBUTION TO UMC ADMINISTRATION. THE COMMITTEE MEETING ROOM IS ACCESSIBLE TO INDIVIDUALS WITH DISABILITIES. WITH TWENTY-FOUR (24) HOUR ADVANCE REQUEST, A SIGN LANGUAGE INTERPRETER MAY BE MADE AVAILABLE (PHONE: ). 2 Page 3 of 33

3 University Medical Center of Southern Nevada Governing Board Strategic Planning Committee June 7, 2018 UMC ProVidence Suite Trauma Building, 5 th Floor 800 Hope Place Las Vegas, Clark County, Nevada Thursday, June 7, :00 a.m. The University Medical Center Governing Board Strategic Planning Committee met in the ProVidence Suite, UMC Trauma Building, 5 th Floor, Las Vegas, Clark County, Nevada, on Thursday, June 7, 2018, at the hour of 9:00 a.m. The meeting was called to order at the hour of 9:00 a.m. Chair Hagerty and the following members were present, which constituted a quorum of the members thereof: CALL TO ORDER Board Members: Present: Harry Hagerty, Chair Robyn Caspersen Dr. Mackay Christian Haase Mary Lynn Palenik Via Phone (Left the call at 9:55am) Renee Franklin - Via Phone Absent: None Also Present: Mason VanHouweling, Chief Executive Officer Tony Marinello, Chief Operating Officer Vick Gill, Associate Administrator, Operations Carissa Rey, Associate Administrator, Operations Terra Lovelin, Board Secretary SECTION 1. OPENING CEREMONIES ITEM NO. 1 PUBLIC COMMENT Chair Hagerty asked if there were any persons present in the audience wishing to be heard on any item on this agenda. None present Page 4 of 33

4 UMC Governing Strategic Planning Committee June 7, 2017 Page 2 of 6 ITEM NO. 2 Approval of minutes of the regular meeting of the UMC Governing Board Strategic Planning Committee meeting on April 12, (For possible action) FINAL ACTION: A motion was made by Dr. Mackay that the minutes be approved as recommended. Motion carried by unanimous vote. ITEM NO. 3 Approval of Agenda (For possible action) FINAL ACTION: A motion was made by Member Caspersen that the agenda be approved as recommended. Motion carried by unanimous vote. SECTION 2. BUSINESS ITEMS ITEM NO. 4 Receive an update on employee wellbeing; and direct staff accordingly. (For possible action) DOCUMENT SUBMITTED: - Nursing Wellness & Resiliency Updates DISCUSSION: Deb Fox, Chief Nursing Officer presented an update regarding nursing and the current state of nursing turnover, burnout and what UMC is doing to combat it at UMC. UMC s nurse turnover rate is at a historical low of 10-11% and compared to the national average of 18%, this is great news. Nurse burnout is reaching epidemic proportions across US hospitals and the cost of managing nurse vacancy is roughly $68,000 per position. To help combat nursing burnout, tranquility rooms have been created at UMC. We have two certified, full time nurses who are trained in therapeutic therapy. UMC received grants to fund five rooms and two rooms are currently implemented in Trauma and 5 North. These rooms are focused on healing and stress reduction for nurses. If a nurse is feeling stressed while at work, she or he needs only to tell leadership to let them know that 10 or 15 minutes is needed for utilization in the room. While the individual is in the tranquility room they can set appointments for healing touch services, or other services they may find helpful. Staff is now in the process of collecting survey data from everyone that has used the room to see how it has helped them. It was discussed that we should invite the donor and his wife from Tennessee that gifted the funds to make one of the rooms possible to UMC for a tour. Marcia Turner will reach out and see if they are interested. A few nurse wellbeing strategies were discussed and include Code Lavender, which is a system council of shared governance that creates a workflow for immediate crisis debriefing and staff counseling during an emergency. Ms. Fox said she will be working with Aaron Stagg to develop and train this team. Page 5 of 33

5 UMC Governing Strategic Planning Committee June 7, 2017 Page 3 of 6 Ms. Fox is looking for an improvement in bullying and lateral violence. She sees it in nursing and a lot of it is stress related and poor communication techniques. There is a Practice Counsel group of committee members addressing this now and through self-care and training they hope to see improvements. Chair Hagerty thanked Ms. Fox for her presentation and asked her to please keep the committee updated on the progress. FINAL ACTION: None taken ITEM NO.5 Receive an update regarding the countywide trauma process; and direct staff accordingly. (For possible action) DOCUMENT SUBMITTED: - None submitted DISCUSSION: Mr. VanHouweling recapped what happened a few years ago when three hospitals submitted for level three trauma applications. There has not been a clear path to determine the need for more trauma hospitals in the community and we do not believe more is better. The Regional Trauma Advisory Board (RTAB) created a subcommittee which is working on determining the proper need for Trauma centers in the community. This task force is now complete and we will soon see the applications begin again; there could be upwards of six applicants now. Kim Cerasoli, Trauma Program coordinator and RN, sat on the RTAB Board. The subcommittee met monthly for about a year and a half, then they gridlocked. A trauma needs assessment tool was developed by a special task force that went to RTAB to help determine the needs. A gap analysis will be done and hopefully completed by August; applications should start rolling in by September. Chair Hagerty asked if anyone has taken this tool and done a proforma analysis and run potential applicants through it to be able to see the outcomes if certain hospitals obtain Trauma certification. Ms. Cerasoli replied that they are looking at this. Mountain View, Centennial Hills and Southern Hills were the previous applicants. FINAL ACTION: None taken. Page 6 of 33

6 UMC Governing Strategic Planning Committee June 7, 2017 Page 4 of 6 ITEM NO. 6 Receive an update on the strategic partnership between UMC and the UNLV School of Medicine; and direct staff accordingly. (For possible action) DOCUMENT SUBMITTED: - None submitted DISCUSSION: Marcia Turner, Chief Administrative Officer provided an update on the relationship between UMC and UNLV School of Medicine. Multiple subcommittees were formed and these committees meet monthly. There has been quite a bit of new staff members so these committee are beneficial to introduce everyone and keep everyone in the loop. An Epic subcommittee was just formed and this has helped greatly with the transition to Epic for UNLV. It was mentioned that a one year extension to the preliminary affiliation agreement was just executed. Member Caspersen asked Ms. Turner to provide her and the committee with some talking points and monthly updates so she can speak to the community about all the great things that are happening between the two entities. Mr. VanHouweling replied that they can put together a summary that will help keep the Board members informed. Chair Hagerty commented that perhaps they should have a five year plan as to what they want to do together and when. Also, he asked at what point we start to do joint marketing. Mr. VanHouweling replied that we are working on joint marketing with signage now. FINAL ACTION: Provide the Committee with updates to keep them informed of the activities going on between UMC and UNLV School of Medicine. ITEM NO. 7 Receive an update on the educational resource grants received by UMC from the Governor s Office of Science Innovation and Technology and related education and training programs available for UMC staff; and direct staff accordingly. (For possible action) DOCUMENT SUBMITTED: - None submitted DISCUSSION: Marcia Turner explained that UMC has developed a great relationship with the Governor s Office and we have been the recipients of three grants so far. These grants have helped with nurse education and with the purchase of high tech mannequins that blink and bleed. Through the grants UMC Page 7 of 33

7 UMC Governing Strategic Planning Committee June 7, 2017 Page 5 of 6 bought multiple mannequins that can simulate a multitude of injuries and emergencies. The Governor s OSIT grant also helped purchase computers, desk and chairs so nurses who are involved in continuing education, can go to the 2040 building and work on their schooling in a quiet environment. Deb Fox thanked Detannyia Tower, Senior Management Analyst and Noelle Madic, Clinical Supervisor for their passion and operationalizing the money and administering it. This lab is operational because of them. FINAL ACTION: None taken ITEM NO. 8 Receive a report on 4 th Quarter market share; and direct staff accordingly. (For possible action) DOCUMENT SUBMITTED: - Calendar Year 2017 Market Share DISCUSSION: Mr. VanHouweling presented an overview of the 4 th Quarter and UMC s spot in the market. UMC grabbed 10% or third place in the valley in the market, behind Sunrise and Summerlin. There were multiple UMC services that ranked top 4 in the market or higher and a few of them are listed below: -Orthopaedics 12.3% -General Medicine 12% -Pulmonary 10% -Neonatology 11.6% -General Medicine 14.1% A discussion ensued regarding payor mix and it was noted that Medicaid is the highest payor with 46%, followed by Medicare with 22%, Commercial with 21% and other at 11%. FINAL ACTION: None taken Page 8 of 33

8 UMC Governing Strategic Planning Committee June 7, 2017 Page 6 of 6 ITEM NO. 9 Receive an update on Silver State Accountable Care Organization; and direct staff accordingly. (For possible action) DOCUMENT SUBMITTED: - None submitted DISCUSSION: Mr. VanHouweling stated that UMC has entered into the Silver State Organization per staff direction and with the committee s approval. Silver State has been granted Epic access to view our charts to analyze our quality measures. Silver State was given training by our IT department and went through all the proper security protocols. We are currently working with Experian and we are close to getting the alerts when Medicare patients are admitted under the Silver State ACO. UMC is a preferred quick care and primary care provider for Silver State. Two new ACO s have been established and are attempting to acquire Medicare eligibility so we will be monitoring their performance. FINAL ACTION: None taken ITEM NO. 10 Identify emerging issues to be addressed by staff or by the Strategic Planning Committee at future meetings, and direct staff accordingly. (For possible action) No emerging issues COMMENTS BY THE GENERAL PUBLIC: At this time, Chair Hagerty asked if there were any persons present in the audience wishing to be heard on any items not listed on the posted agenda. SPEAKER(S): None There being no further business to come before the Board at this time, at the hour of 10:47 p.m. Chair Hagerty adjourned the meeting. APPROVED: MINUTES PREPARED BY: Terra Lovelin Page 9 of 33

9 Year End Review Page 10 of 33

10 Operations Total Admissions up 11%, Inpatient Surgeries up 19%, reduction of ALOS by 7%, and QuickCare visits up 3% Year-to-Date Actual Budget Variance % APDs 189, ,514 (10,488) (5.2%) Year-to-Date Actual Prior Year Variance % Total Admissions 23,026 20,794 2, % ADC % ALOS (Admits) (0.43) (7.0%) Hospital CMI Medicare CMI (0.17) (7.9%) IP Surgery Cases 9,499 8,001 1, % OP Surgery Cases 5,521 6,517 (996) (15.3%) Total ER Visits 115, ,133 (4,928) (4.1%) ED to Admission 11.5% ED to Observation 10.5% Quick Cares 166, ,721 4, % Primary Care 54,703 61,124 (6,421) (10.5%) 2 Page 11 of 33

11 Operations Successful Go-live of EPIC in both ambulatory & inpatient Successful triennial Joint Commission accreditation Radiology, Lab, NICU, Stroke, EPA, 7 OSHA, 30+ Nevada Department of Public Health and Ryan White surveys Successful transition to UNLV School of Medicine Opened two new ambulatory clinics (Blue Diamond & Centennial) Workers Compensation visits up by 60% (1,287 additional visits) Open transitional care unit to compensate for increased admissions and improve hospital throughput Implemented new Capacity Management Plan Reduced divert hours by 18% when compared to FY17 From January 2018 to July 2018 further reduction of 96% UMC One Call transfer program to go-live August 15 th, 2018 Converted 50% of ED dialysis patients to OP setting resulting in increased ED throughput 3 Page 12 of 33

12 4 Clinical Excellence 189 physicians credentialed in FY18 (82 in FY17), 43 APP credentialed in FY18 (27 in FY17) Submitted Pathways to Excellence application to the AACN in Summer 2018 (expected designation Fall 2019) 2017 NDNQI RN survey scores improved to Magnet mean or better in every nursing practice area when compared to 2015 survey Launched new rapid response program (MERT) resulting in a decrease of Code Blue calls by 90% Pediatric national benchmarks are 90% or higher in every quality measure Leap Frog for women s services is 4 stars Received 3 stars for outstanding cardiac quality outcomes Initiated Palliative Care program and hired new palliative care physician and nurse practioner Received Silver Pediatric Achievement Award from American Heart Association and were first in NV to receive such an award Implemented new CRRT dialysis program in adult and pediatrics Increase of 22% in clinical research studies Page 13 of 33

13 Finance HPG with 87% compliance; savings of $3.5M in FY18 and expected savings of $3.7M in FY19 (including capital) Implemented cost savings plan which resulted in savings of over $10M in a six month period SWB Cost Savings of $5.8M Revenue Improvements of $3.5M Supply Cost Savings of $208,000 Rent/Lease/Purchase Service savings of $635,000 Daily productivity Started comprehensive analysis of service line costing 5 Page 14 of 33

14 Finance Revenue / Cost Savings Improvement Plan 17-Dec 18-Jan 18-Feb 18-Mar 18-Apr 18-May 18-Jun TOTAL SWB Cost Savings $290 $1,045 $1,065 $836 $875 $813 $853 $5,777 Revenue Improvements $388 $305 $483 $445 $674 $416 $840 $3,551 Supply Cost Savings $13 $14 $46 $30 $19 $40 $46 $208 Rents / Leases / Purchased Srvcs Total Savings / Improvements $13 $30 $78 $36 $124 $201 $153 $635 $704 $1,394 $1,672 $1,347 $1,692 $1,471 $1,892 $10,172 (000 s omitted) 6 Page 15 of 33

15 Community Engagement Successfully hosted POTUS, Governor of NV, Senators and Congressmen Provided Stop the Bleed training to more than 5,000 community members Shared lessons learned from the October 1 shooting at conferences across the nation, helping other health care organizations prepare for mass casualty incidents Strengthened sports and event medicine, including new partnerships with the Vegas Golden Knights, the Las Vegas Lights FC, NASCAR, and Las Vegas Aces Celebrated UMC patients at NICU Reunion, Living Donor Reunion and Trauma Survivor Luncheon Received several awards from the American Heart Association and American Stroke Association, recognizing UMC s commitment to implementing high standards of care Offered approximately 580 health and wellness classes for community members and employees at the Healthy Living Institute at UMC, providing sessions focused on a wide variety of health topics Engaged with community members at more than 70 health fairs and events, including outreach to local senior centers, Caesars Entertainment properties, Station Casinos, McCarran International Airport and many other organizations 7 Page 16 of 33

16 Employee Engagement Conducted an in-depth Employee Engagement Survey, which found: Employees use icare4u in every interaction about 90% of the time 85% of employees are proud to tell others that they work at UMC 81% of employees would recommend UMC to their own families and friends for health care 77% of employees stated that icare4u is still an effective approach toward culture change and an excellent way to improve patient and colleague experiences 74% of employees feel they have the right and most effective tools and resources to do their jobs effectively UMC Strong Celebration, Holiday Party, Employee Picnic, Town Halls, TeamUMC, Employee Service Awards Zappos Partnership Holiday Meals for employees working during the holidays Sent Caught You Caring cards & gift cards to employees homes to recognize positive patient comments First nationally certified nursing residency in the state Nurse turnover at 8%, down from 18% in Page 17 of 33

17 Capital EPIC EHR conversion in ambulatory & inpatient setting Cardiology Cath/EP Lab approval (go-live by end of FY19) New 3T MRI (Go-live late August 2018) Globus GPS navigation for Spine Surgery (first in NV) Emergency Department expansion & renovation New telemetry system New Physicians Lounge and Trauma unit refresh All new Siemens lab (Go-live November 2018) New robotic table Sim Lab implementation from a $500,000 STEM grant $3M AG Grant for Women s and Children s services Certification Review courses for 12 specialties, unlimited licenses based on a $375,000 STEM grant New IV pumps & adult and pediatric crash carts All digital X-Ray in inpatient and ambulatory settings General facility maintenance TEG testing for Trauma and CVT surgery 9 Page 18 of 33

18 Market Dynamics Page 19 of 33

19 Page 20 of 33

20 Service Line Strategic Growth Page 21 of 33

21 Level 1 Trauma & Children s Hospital Comprehensive service lines - One and Only Unique academic based learning environment 80+ year relationship with community UMC governing board Longstanding provider relationships Only safety net mission in the state Expanded QuickCare presence in LV Valley Positive overall reputation with community Strong relationship with EMS, fire, police & unions Poor Payor Mix within PSA Limited bed capacity to grow beyond current market share Outdated facility with aging infrastructure High benefit structure in comparison to market Impression in community as a county hospital vs Academic Medical Center Inability to consistently place patients for postacute needs secondary to payor mix Structural constraints in negotiating with payors Contracts with payors/providers Expansion of Service lines for elective volume Expansion of strategic alliance with UNLV Master Plan of campus expansion Capital Investment Future risk based agreements Clinically Integrated Network/ ACO for riskbased payor agreements Continued dedicated funding source Develop reputation with community as a true Academic Medical Center Development of the Medical District Enhance Community-Provider Relationship Philanthropy & Grant opportunities Designated Trauma expansion Expansion of competing hospitals Possible repeal of ACA/ state changes in Medicaid Changes in DSH/IGT funding Proliferation of stand alone EDs/MicroHospitals New GME programs diluting academic brand Consolidation of outpatient insurance based organizations controlling & limiting access to provider networks New Regulations (federal and state) Inappropriate use of ED driving up uncompensated care Page 22 of 33

22 General Medicine Obstetrics Cardiovascular Newborn Health Orthopedics Gastroenterology Neurology Pulmonary General Surgery Urology Page 23 of 33

23 Orthopedics Market Share Analysis 2017 Orthopedics Inpatient & Outpatient Market Share Quarter Comparison 4% 3% 2% 12% Mountain View Sunrise 14.7% 15.6% 14.4% 15.5% 5% Spring Valley University Medical Center 12.5% 6% 12% Saint Rose - Siena Summerlin Desert Springs 6% Valley Centennial Hills Southern Hills 7% 12% Saint Rose -San Martin Henderson Saint Rose - De Lima 8% North Vista 10% 10% Medicaid Medicare Commercial 35% 9% 18% Market Payor Mix 28% 12% UMC Payor Mix 41% Inpatient Outpatient Total Q1 17 Q2 17 Q3 17 Q4 17 Q or 14.1% 533 or 15.4% 1,060 or 14.7% 563 or 15.5% 543 or 15.7% 1,106 or 15.6% 555 or 15.7% 404 or 12.8% 959 or 14.4% 583 or 14.9% 316 or 9.6% 899 or 12.5% 591 or 15.5% N/A 591 or 15.5% Other 38% 20% 4 Page 24 of 33

24 Hospital Strategy Grow and develop additional volume while reducing cost per case through implant standardization, maximizing OR time and introducing new elective procedure offerings to enhance service line Operations and Finance Improved service line analysis (payor mix/margin) with EHR transition Reduce clinical variation and improve HPG compliance Block time optimization Enhanced clinical coverage with 3 rd year residents Additional Physician Training on GPS Better utilize existing clinic space in hospital Physician champion of service line to improve OR operations Physician & Business Development Recruit and attract additional Orthopaedic Surgeons (Sports, Joint, Peds, Trauma) through UNLV School of Medicine Orthopedic Department to increase elective case volumes Create in-house Orthopaedic Clinic for post and pre surgery care of UMC patients Alignment with Air Force on newly recruited spine surgeon for higher level of care surgeries Patient Education (Joint Classes) with Healthy Living Institute Capital Plan Globus Excelsius GPS (Spine) Provide additional renovations to meet needs of Ortho Clinic at UMC Navigation, surgical hardware, drills, anesthesia machines recently replaced Long-range capital needs assessment for enhanced service line Allocated capital resources for new Orthopedic service lines Page 25 of 33

25 Surgical Services Market Share Analysis 2017 Surgical Services Inpatient & Outpatient Market Share 6% 6% 4% 7% 4% 8% 3% 4% 9% 12% 10% 12% 12% UMC Sunrise Mountain View Summerlin Saint Rose- Siena Spring Valley Valley Desert Springs Centennial North Vista Saint Rose-San Martin Southern Hills Henderson Saint Rose - Rose De Lima Quarter Comparison 13.7% 11.8% 11.6% 11.4% 14.2% Medicaid Medicare Commercial 35% 5% Market Payor Mix 21% 27% 9% UMC Payor Mix 39% Inpatient Outpatient Total Q1 17 Q2 17 Q3 17 Q4 17 Q or 12.0% 257 or 11.5% 517 or 11.8% 253 or 11.3% 260 or 12.0% 513 or 11.6% 336 or 15.5% 290 or 12.1% 626 or 13.7% 331 or 13.6% 197 or 9.0% 528 or 11.4% 338 or 14.2% N/A 338 or 14.2% Other 39% 25% 6 Page 26 of 33

26 Hospital Strategy To increase volumes in accretive surgical specialties such as ENT, Plastics, Colorectal, GYN, Pediatric, Urologic, Cardiothoracic and Neurosurgery while optimizing OR utilization and introducing state-of-the-art equipment as a market differentiator. Physician & Business Development New ENT, Pediatric and GYN surgeons onboarded New Air Force surgeons (Colorectal) 2 nd Transplant surgeon Train additional robotic techs for increased robotic volumes Add additional capacity within OR for addon and cardiac cases Target Medicare population (Senior Celebrations) Service line dedicated teams Operations and Finance Capital Plan Stealth Navigation (Cranial) Expanded OR coverage during the week and Surgical Microscopes (ENT/Plastics) weekend by 10% New Cardiac Bypass Machines, Ultrasound and Greeley engaged to improve block scheduling Probes for Heart Program and throughput New mobile Robotic OR table Flex OR block scheduling New GI Endo suite equipment Tissue tracking system for biologics to reduce Liver dialysis machine (MARS) supply cost New OR lights/sponge count machine Frozen section room to reduce OR time New TEG lab test to improve blood product New OR to assist in add-on cases and decrease utilization bumping New ultrasound for colorectal surgery Business manager in OR for supply New Trauma OR Lights w/ cameras (FY19) standardization Deep Brain Simulation Revenue cycle analysis for root cause of denials Future robotic expansion Page 27 of 33

27 Cardiology Market Share Analysis 7% 7% 5% 2017 Cardiology Inpatient & Outpatient Market Share 4% 9% 3% 3% 2% 9% 15% 10% 11% 14% Mountain Sunrise Saint Rose - Siena Desert Springs University Medical Center Summerlin Valley Spring Valley Centennial Hills Saint Rose -San Martin Southern Hills Henderson North Vista Saint Rose - Rose De Lima Quarter Comparison 9.1% 9.3% 9.4% 7.9% 6.9% Medicaid Medicare Commercial 26% 6% 15% Market Payor Mix 21% 11% UMC Payor Mix 24% Inpatient Outpatient Total Q1 17 Q2 17 Q3 17 Q4 17 Q or 7.8% 555 or 11.2% 1,157 or 9.1% 597 or 8.1% 555 or 11.0% 1,152 or 9.3% 555 or 7.6% 594 or 12.1% 1,149 or 9.4% 570 or 7.3% 424 or 8.8% 994 or 7.9% 563 or 6.9% N/A 563 or 6.9% Other 53% 45% 8 Page 28 of 33

28 Hospital Strategy To continue to grow catheterization, echo and ECG procedural volumes while expanding EP offerings in a more efficient state-of-the-art lab by recruiting more community physicians to practice at UMC. Physician & Business Development Add EP outpatient volume to cardiology service line Leverage EMS coordinator with first responders (STEMI activations) as quality measures indicate UMC as a market leader Align patient referral system with preferred provider network 2 nd CVT Surgeon & UMC based clinic Promote AHA Center of Excellence Increased dedicated time, physicians, and space to Heart Failure Clinic Operations and Finance Capital Plan New line of business EP studies LVAD Monitoring Device New CardioMems system for Reviewing LVAD primary comprehensive heart failure care placement site Increase space of Echo Lab to improve Cath & EP Lab Remodel efficiencies of outpatient procedures Cupid/EPIC build out Participate in LVAD Shared Care Program 3 rd Heart Room for heart transplant patients Realigning Heart Clinic for patient Research and implementation of TAVRs satisfaction and accommodate market program (valve replacement) share increases Impella (started with left procedures and now doing right sided) Page 29 of 33

29 Pediatrics Market Share Analysis 2017 Pediatrics Inpatient & Outpatient Market Share 6% 6% 5% 3%2% 1% 27% Sunrise Summerlin University Medical Center Saint Rose - Siena Spring Valley Quarter Comparison 15.6% 15.9% 15.5% 14.3% 12.4% 11% Centennial Hills Mountain View Saint Rose-San MartiN 15% 23% Southern Hills Henderson 5% 6% Q1 17 Q2 17 Q3 17 Q4 17 Q1 18 Medicaid Commercial Other 39% Market Payor Mix 56% 19% UMC Payor Mix 75% Inpatient Outpatient Total 1,094 or 12.4% 1,050 or 21.5% 2,144 or 15.6% 1,042 or 12.2% 1,079 or 22.7% 2,121 or 15.9% 1,026 or 11.5% 1,087 or 23.2% 2,113 or 15.5% 1,177 or 13.2% 744 or 16.7% 1,921 or 14.3% 1,137 or 12.4% N/A 1,137 or 12.4% 10 Page 30 of 33

30 Hospital Strategy Enhance outreach to Las Vegas community to increase commercial volumes in Pediatric ED which will drive higher level care to the Pediatric ICU and improve revenue in service line. Operations and Finance Sheer Foundation/equipment upgrade NAT program, Back to Sleep, March of Dimes discharge education New treatment room March of Dimes Scholarship-leadership national conference March of Dimes grant. NICU discharge education Website remodel to promote services & physicians Physician & Business Development New PEDS ED Fellowship Program Stronger alignment with UNLV Peds physicians (Lied Clinic) 2 new pediatric surgeons Pediatric Surgery Center of Excellence OB connection to NICU/ER Services U.S. Air Force Nellis- one call protocol Promote VPS outcomes Children s spinal & heart cases Pediatric Sedation Capital Plan New Philips Bedside Monitors (FY18) AG grant- remodel of L&D and upgrade to security Pediatric emergency room remodel with additional 6-8 beds and Education Center New Surgical/Procedure suite in PICU Ultrasound for ED Refresh family waiting room Play room remodel-clair s Place Treatment room remodel New pediatric security system CertaScan and Zoom systems for newborns Page 31 of 33

31 Ambulatory Trending Ambulatory Visits by Month 18,101 16,094 16,388 11,697 11,918 12,931 13,524 14,318 14,797 14,014 12,514 10,134 3,268 4,017 4,247 5,060 4,687 3,810 4,720 4,574 4,939 5,074 5,237 5,070 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Quick Care Primary Care 12 Page 32 of 33

32 Ambulatory Strategy UMC QuickCare serves an integral role in providing increased access for patients as they navigate the continuum of care within UMC s clinically integrated network. Physician & Business Development Telemedicine Explore opportunities for urgent care to the home which will: Increase Primary Care visits Increase appropriate ER volume Reduce readmissions through post discharge follow-up Outpatient infectious disease clinic Expanded Workers Compensation services Chronic Care management Operations and Finance Capital Plan One Call /Clinical Decision Unit 2 new locations at Blue Diamond and (Concierge/Take me to UMC) Centennial (FY18) Extended hours of operation Digital X-ray in all locations (FY18) Maximize Comprehensive Exams Improve Merit-based Incentive Payment Market assessment of primary & System (MIPS) urgent care locations in LV for possible Align Physician Compensation program future locations Increase Nurse practitioners 2 nd Workers Compensation clinic Implement SSACO Initiatives Aesthetic renovations of all clinics to Wellness Exams include patient care areas Colorectal Cancer Screening Renovate 2231 Charleston Breast Cancer Screening Page 33 of 33