devoted physicians. collaborative partners. metrics-driven quality. jlrmedicalgroup.com

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 2 devoted physicians. collaborative partners. metrics-driven quality. jlrmedicalgroup.com

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 3 [ ] Because of the support and collaborative partnership we enjoy with JLR, we are able to meet the ever-growing demands of our community. Their leadership is accountable, quick to become a part of the solution, and proactively finds ways to remove barriers to accomplish our organizational goals. JLR positively impacts the quality of care we are able to provide by ensuring the provider schedule matches our demand; therefore decreasing patient delay and overall length of stay. JLR is always at the table with our executive leadership to understand metrics and outcomes. It is clear they support us in a way that benefits the overall patient experience and furthers our mission. - Heather Long, Chief Nursing OfficerFlorida Hospital Altamonte

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 8 YOUR CHALLENGES At JLR, we understand the challenges you face: Increased demands for quality, efficiency and accountability Staffing issues/shortages Continually evolving healthcare reform and regulatory changes Effectively negotiating payor contracting rates Ensuring patient safety And we also understand the increased importance and critical role your anesthesiology team plays in meeting these challenges head on. In fact, perioperative services now drive about 60 percent of hospital revenue. confidence, trust, experience, expertise 1

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 5 Do You Have Confidence in Your Perioperative Team? To effectively manage today s OR and achieve the highest standard of care, you need a professional team with business savvy and experienced medical leaders who are at the top of their field. Unlike outsourced anesthesia staffing, JLR will protect both your brand and your bottom line. 75 anesthesiologists and 120 nurse anesthetists perform over 100,000 cases per year demonstrate leadership 2

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 10 Meet JLR Medical Group Inc. Your Vision is Our Mission Founded in Orlando, Florida, in 1988 by Joseph L. Riley, MD, JLR Medical Group is a physician-owned, perioperative services company, providing anesthesia services and pain management throughout Central Florida. Our growing clinical team of 75 anesthesiologists and 120 nurse anesthetists perform over 100,000 cases per year. Positioned for the evolving healthcare landscape, we offer a complete, streamlined medical and management solution to achieve an optimally performing operating room: Medical and business leadership Regulatory experience Financial stability Quality management and accountability Clinical experience and expertise JLR s experienced team balances business effectiveness and efficiency with providing the highest caliber patient care and safety. We closely partner with our clients and take a creative, problem-solving approach to analyze challenges and generate solutions. OUR VISION: To demonstrate leadership in perioperative streamlining by driving efficiency, quality care, safety, and measured outcomes. OUR MISSION: To serve as an integral medical team partner to restore health, provide comfort and relieve suffering within a culture of collaboration, compassion and innovation. in perioperative streamlining by driving efficiency 3

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 11 Highly Aligned with Your Goals Leadership and Experience At JLR, we are more than a simple service provider -- we become part of your team and believe in closely aligning our medical team with your organizational goals and operating room managers to achieve: Perioperative efficiency Optimized OR throughput Enhanced quality metrics [ ] While previous relationships in my career were often adversarial. JLR has been a true business partner from day one, and our approach as partners enhances smart business decisions. We collaborate as equals, and they have been very responsive to any requests. As an example, our exceptional performance in SCIP is partly due to our partnership with JLR. The high caliber of skills and professionalism of the providers is the best I have experienced in 25 years. They provide consistent, safe, high-quality patient care. They are partners, not just providers. -- Daniel Magnusson, Director of Surgical Services, Florida Hospital Altamonte JLR physicians have long been active outside the OR, providing input, perspective and expertise in administrative, research and policy forums throughout the hospitals and institutions that we serve. Several JLR anesthesiologists serve as: Medical Staff Presidents Division Leaders Hospital Committee Chairs Governance Committee Members Operations Committee Members Clinical Improvement Committee Members Our specialized and experienced administrative team provides a full range of business functions and support: Contract Negotiation Billing Management OR Analysis Staffing Scheduling Payroll 4

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 14 The JLR/PDM Diamond Report: A Powerful Tool to Examine and Adjust OR Efficiency Perioperative Streamlining Our perioperative physicians take a leadership role from pre-testing through the OR and into the PACU, impacting efficiency through: Minimizing cancelled surgeries Increasing patient throughput Decreasing length-of-stay by tracking outcomes to minimize side effects and complications Improving patient safety and satisfaction Increasing reimbursement rates [ ] I have worked with JLR for 16 years, and they are very responsive and work as partners in the care of my patients. Their work with peripheral nerve blocks improves post-op and PACU management, and decreases the need for narcotics, reducing nausea and vomiting. I have confidence that they will do the very best they can for each patient while also allowing me to increase my surgery volume and decrease turnover time. On a more personal note, my father, wife and daughter have all had anesthesia administered by JLR, and I have all the confidence in the world with their skill and knowledge. I trust them with my patients and family. Custom-designed and developed in partnership with Professional Data Management (PDM) and approved through the Florida Anesthesia Administrators Association, JLR s proprietary Diamond Report provides each of our clients a detailed picture of their operating rooms by looking at the start and stop times of all cases performed at all times of the day. Running millions of calculations in a matter of seconds and downloaded directly from the JLR/PDM billing system, the Diamond Report generates views to help improve operating room profitability through: Adjusting staffing levels Setting call responsibilities Identifying surgeons who start late Identifying holes in the OR schedule -- Craig Mintzer MD, Orthopaedic Surgeon, Jewett Orthopaedic Clinic, Head Physician for the NBA s Orlando Magic 5

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 15 Regulatory Experience At JLR Medical Group, we believe that when it comes to regulatory compliance, prevention and preparation are the best medicine. We know auditors show up unannounced, which is why our experienced, specialized team makes sure our clients are prepared. JLR s physician leadership and compliance officers have worked with both the Joint Commission on Accreditation of Healthcare Organizations (JHACO) and DNV, and provide guidance to the hospitals, surgery centers and office-based practices we serve. OUR EXPERTISE COVERS: Centers for Medicare and Medicaid Services (CMS) -- Quality Assessment and Performance Improvement State Requirements -- Quality Improvement Provider Credentialing, Privileging and Licensure The Joint Commission -- Credentialing and Privileging Standards: Ongoing Professional Practice Evaluation and Focused Professional Practice Evaluation Billing Compliance Officer of Inspector General -- Fiduciary Responsibility of the Board False Claim Act - Documentation Quality of Care, Standard of Care Met Office of Inspector General (OIG) Compliance Guidance Pay-for-Performance CMS - Physician Quality Reporting System (PQRS) CMS - Surgical Care Improvement Project (SCIP) COLLABORATIVE PERFORMANCE IMPROVEMENT METRICS-BASED ASSESSMENT ROBUST COMPLIANCE PERIOPERATIVE STREAMLINING CLINICAL QUALITY IMPROVEMENT 6

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 16 YOUR CHALLENGES: We know that many hospitals, in particular, face challenges with anesthesia services including: OUR SOLUTIONS: Minimizing Stipends and Maximizing Revenue-cycle Management A national shortage of anesthesiologists and CRNAs, causing a dramatic increase in the costs to hire and retain qualified practitioners An increasing Medicare and Medicaid population whose anesthesia services fall so far below the rates of commercial carriers that they do not cover the costs of nurse anesthetists, much less anesthesiologists The need to provide large stipends to ensure adequate anesthesiology coverage Challenges negotiating managed care contracts JLR Medical Group knows you want to provide the highest quality anesthesiologists to anchor your department without sacrificing financial stability. With JLR, you can ensure that the business functions of your anesthesiology group are as competent as the clinical practice. Our experienced, specialized team minimizes stipends while at the same time, maximizing revenue-cycle management. We accomplish this by: Aligning streamlined coverage with efficiently scheduled ORs Capturing improved reimbursement through superior managed care contracting JLR s business structure and billing services team will improve your OR performance by working collaboratively with surgical administration and clinical leaders to adjust blocks, minimize delays and provide flexible coverage. We are continually evaluating utilization and adjusting staffing models to improve OR efficiency. And because of our size, alliances and regional dominance, we can effectively negotiate contracts and pass along savings to our clients. 7

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 13 Quality & Accountability At JLR Medical Group, patient safety and quality have always been paramount. That is why we have partnered with industry-leader FIDES to measure, track and report quality data on every case we perform. A COMPREHENSIVE APPROACH: Clarity, Consistency and Detail A proven, refined program founded by anesthesiologists, FIDES has 18 years of experience producing anesthesia quality data. Their tools, including simple checklists, allow us to easily and cost effectively measure and compare quality data at the deepest levels -- by facility, site, service line, provider and payer, across more than 100 different data points, including: Demographics -- Age, Race, etc. Planned Disposition Anesthesia Type ASA Class Risk Factors Outcomes measured include: Pre-op Delays Intra-op Observations Core Temperature Post-op Antiemetic Post-anesthesia Observations Post-PACU Observations Satisfaction Survey Prophylactic Antibiotics Post-anesthesia Data Blood Sugar Vomiting Delay in Discharge Post-discharge Follow-up Comments with Image 8

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 12 Quality & Accountability Benchmarking And through FIDES, we are able to benchmark this data against ourselves as well as against more than 700 anesthesiologists in 20 other anesthesiology groups across the country. This benefits everyone -- patients, our client hospitals and surgery centers, surgeons, and our own medical team alike. Charge Anesthesiologists In JLR s efforts to work with our clients to improve perioperative streamlining, and patient satisfaction/safety, we staff anesthesiology personnel in a care team model with a supervising Charge Physician who takes on the role of air traffic control for an OR, not just for the day but for a week at a time. This unique approach aids in consistent communication and transfer of information throughout the workday, keeping operations running smoothly and efficiently by proactively dealing with issues that arise. The Charge Anesthesiologist can address challenges like abnormal or missing lab tests, minimizing delays and turnover between cases. This operations model also aids with staffing consistency and anticipating surgeons needs. Peer Review and Evidence-based Care Our experienced and accomplished JLR clinicians are also deeply invested in peer review and evidence-based care, and we back that up with our advanced metrics to yield clinical excellence. Quality & accountability benefits everyone -- patients, our client hospitals and surgery centers, surgeons, and our own medical team alike. 9

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 9 Exceptional Training = Medical Leadership and World-class Care JLR Medical Group s anesthesiologists have trained at many of the best hospitals throughout the country according to U.S. News and World Report: Harvard s Massachusetts General Hospital and Brigham and Women s Hospital Stanford Hospitals and Clinics Mayo Medical Center Johns Hopkins Hospital Yale-New Haven Hospital Duke University Medical Center University of California, San Francisco Medical Center Emory University Hospital Wake Forest Baptist Medical Center Boston Children s Hospital University of Florida Shands Hospital JLR s experienced anesthesiologists are at the top of their class and lead in their field: Trained at many of the best hospitals in the United States according to U.S. News and World Report Research and develop breakthrough medical treatments that are improving outcomes, safety and patient satisfaction Provide subspecialty anesthesiology care: Complex cardiothoracic and transplant procedures Cutting-edge neurosurgery Advanced regional anesthesia Neonatal and Pediatric care Over 8,000 annual labor and delivery procedures Pain management Premier orthopaedic care for sports medicine and joint replacement [ ] JLR provides me with peace of mind that my patients are getting world-class anesthesia care. Working together for 18 years, we have a long record of safety, and I appreciate their ability, training, and broad experience in plastic surgery. They understand what I do and are able to appreciate the nuances of my subspecialty, ensuring outstanding patient care. - Clifford Clark, MD, Orlando Aesthetic Institute 10

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 6 JLR Anesthesia is one of the most professional and excellent medical groups I have ever worked with. The hallmark of their work is outstanding clinical outcomes. Patients do so well under their care. Surgeons enjoy and appreciate the professionalism, team spirit and working together with JLR. I have worked for Florida Hospital for 27 and a half years. I have worked in an executive capacity, directly along with JLR, for more than 19 years. Having led three of Florida Hospital s acquisitions (Kissimmee, Winter Park and Winter Park ASC), I had the privilege of inviting JLR anesthesia to take over from previous providers. I made this decision because of their clinical quality, their devotion to Florida Hospital and their dedication to their patients. In two cases, contractual issues required an almost immediate takeover from JLR. There were no qualms or concerns about being able to staff busy operating rooms. Their doctors and CRNAs jumped right in with no complaints. They were able to take over and continue service without any hesitancy or gaps. These were no small feats. Major partners of the group even delayed planned vacations so they could take shifts and help out. For the success of these transitions, I will be eternally grateful. JLR continues to advance. Over the past three years at Winter Park, I have watched JLR thought leaders develop now one of the nation s foremost surgical pain interventional programs. Their devotion to learning and applying new regional techniques has had stunning patient and business improvements for orthopedic surgery. Their skills in regional anesthesia and nerve blocks have dramatically reduced post-operative pain and complications. They have entered into clinical trials and research, along with expanding this application now to other surgical specialties. Their doctors have embarked on this with patient safety first and foremost. The doctors and nurses of JLR are their best asset. They truly are caring individuals. They believe faith makes a difference including many who pray with their patients. As individuals, they are a lot of fun. In my capacity as Mayor of Winter Park, I have met many of the doctors who live in my community outside of the hospital. I know them to be excellent citizens, supporters of an improved quality of life and just good friends. I am always impressed serving at a community hospital of the sub-specialization and rotations of their team throughout the Florida Hospital system. To know today s case may be handled by an anesthesiologist who worked in open heart surgery yesterday provides an extra level of knowledge and comfort. The partnership Florida Hospital has with JLR is one where both parties have the same goals clinical excellence, growth and financial success. Over the years, JLR has increased their management prowess to include helping the hospital better manage the operating rooms. This is a prime example of how the partnership works well. As Florida Hospital grows (both by adding campuses or adding OR s), JLR has grown alongside. Over the past several years, JLR s commitment to the Adventist University of Health Sciences addition of a CRNA Master s program has been exemplary. They have provided counsel, financial investment, clinical sites and hired graduates. This is a stellar example of the continuation of the partnership. My first involvement with JLR was in 1965 when I had my tonsils removed as a child. Dr. George Miles was the anesthesiologist. This was a major event in my life made better by Dr. Miles kindness and care. Much has changed in anesthetics since that time, but the kind professionalism evident by JLR s team has never wavered. It was my privilege to know Dr. Joe Riley. It is my privilege to now work with the team that bears his name JLR Anesthesia. Ken Bradley CEO, Winter Park Memorial Hospital, A Florida Hospital 11

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 7 building long-term relationships At JLR, we believe in building long-term relationships and partnering closely with all of our clients to achieve optimal perioperative performance and the highest quality of patient care. To that end, we have worked with several of our clients for more than a decade and some for 25 years. Hospitals Florida Hospital, since 1988 Florida Hospital Orlando Florida Hospital Altamonte Florida Hospital Celebration Health Florida Hospital Winter Park Memorial Florida Hospital East Orlando Florida Hospital Kissimmee Florida Hospital Fish Memorial, since 2001 Florida Hospital DeLand, since 2005 Florida Hospital Waterman Office-based and Outpatient Surgery Centers Downtown Surgery Center, since 1998 University Surgery Center, since 1993 Physicians Surgical Care Center, since 1995 Celebration Surgery Center, since 2007 Center for Reproductive Medicine Orlando Aesthetic Institute, since 2006 Orlando Plastic Surgery Center/Orange Avenue Surgical Suite (OASIS), since 2007 Reproductive Medicine Institute, since 2011 Women s Care Florida, since 2010 Aesthetic Enhancements, since 2010 Winter Park Urology Associates, since 2005 12

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 4 [ ] The JLR team is skilled, professional, and held in high regard by our patients, staff, and medical staff alike over the past 20 years. Their highly competent providers are fully engaged in our process, ensuring smooth and efficient operations, and assisting us with achieving our desired metrics. Positive patient outcomes are their priority, and the care they provide is unprecedented. -- Mary D Alessandro, Surgical Services, Nurse Manager, Florida Hospital Altamonte

JLR-services-brochures-PS_Layout 1 4/4/13 10:23 AM Page 1 291 Southhall Lane Suite 201 Maitland, Florida 32751 407.667.0444 jlrmedicalgroup.com