stlukescr.org

January 2013

BUSINESS EDITION

Transforming the future of healthcare

Collaborative cancer care PAGE 1

Exceeding heart attack care standards PAGE 3

Coordinated care improves outcomes PAGE 7

B E A T

St. Lukes

Our mission: To give the healthcare wed like our loved ones to receive. To read more about St. Lukes Mission & Core Values, go to stlukescr.org/mission.

Transforming the future of healthcare

Healthcare is rapidly changing and S

t. Lukes is leading the change. Our abil-

ity to provide high-quality, cost-effective car

e is enabled by our commitment

to innovation, investment in advanced techn

ology, a strong partnership with local

physicians and many outstanding associate

s who strive to give the healthcare wed

like our loved ones to receive.

St. Lukes is a founding member of the Iowa

Health System (IHS), an organization

formed more than 15 years ago as we saw t

he need to contain costs and provide

better patient care. Many stand-alone organ

izations are just now looking for ways

to work together in an era of broader system

s and accountable care. This trend will

continue but St. Lukes and the IHS have be

en ahead of this curve for a long time.

Weve developed an organized system of ca

re involving our own providers and

other organizations within our region who

are willing to commit to the same goals

of reducing hospital readmissions, help chr

onically ill patients manage their condi-

tion, eliminate tests that arent necessary, red

uce costs and raise the level of care.

Its a big change. We are focused more than

ever on delivering the best outcome

for every patient every time. Our efforts ha

ve not gone unnoticed as weve been

identified as a high-quality, cost-effective hea

lth provider. We are the only hospital

in eastern Iowa to earn national recognition

as a Top 100 Hospital.

At St. Lukes, weve transformed our care te

ams to put you, the patient,

at the center of your care. Our approach ma

kes sure you, your family and

everyone on your healthcare team discuss t

he same information, giving you

greater confidence as you make decisions a

bout your care.

As healthcare continues to change, we hope

you find comfort in knowing

St. Lukes is leading the change with advanc

ed capabilities and local integrated

care for a better overall patient experience.

After all, thats what youd expect from

a hospital ranked as one of the nations Top

100 Hospitals.

Ted Townsend, St. Lukes President & CEO

Brian Scott, St. Lukes Board Chair

On the cover Left to right: Ted Townsend, St. Lukes President & CEO & Brian Scott, St. Lukes Board Chair

Connect with St. Lukes at stlukescr.org

Does a Top 100 Hospital ranking matter?When you or a loved one needs a hospital, the quality of care you receive is vitally important. To choose where you go, you need objective information. And thats where the right rankings and studies can help. Truven Health Analyt-ics is the accepted leader in healthcare ratings since 1993. Their data from nearly 3,000 hospitals includes patient safety, length of stay, survival stats, cost effectiveness and patient ratings. And Truven has designated St. Lukes as eastern Iowas only Top 100 Hospital based upon factual data not opinion.

The Top 100 ranking confirms St. Lukes as the regions leader in medical care. We offer experi-

ence, expertise and the latest technol-ogy for what really matters the best outcome for every patient every time.

1St. Lukes Health Beat Business Edition |

Kerri Nowell, MD and Robert Brimmer, MD, Physicians Clinic of Iowa Surgical Specialists

~ IOERT treats the precise area where most breast cancers recur ~

This is exciting technology, which gives early stage breast cancer patients another treatment option, said Robert Brimmer, MD, Physicians Clinic of Iowa general surgeon. It eliminates weeks of radiation treatment and applies radiation precisely where most breast cancers recur. Patients will only need three weeks of radiation therapy following surgery. Patients who dont receive IOERT typically require six weeks of radiation therapy. IOERT

delivers a single targeted dose of radiation directly to a tumor site during surgery.

During surgery, after the doctor removes the tumor, a radiation oncologist applies a concentrated dose of electron beam radiation directly to the tumor bed. A shield and cone protect healthy tissue from unnecessary radiation. In one to two minutes patients receive radiation equal to five to seven daily radiation treatments. Studies show IOERT offers low recurrence rates because it treats the precise area where most breast cancers recur.

Call 319/369-7216 to speak to a Breast Care Coordinator or go to radiationduringsurgery.com.

Providing local, collaborative cancer care that is physician-led and patient-focused thats the mission of the Helen G. Nassif Community Cancer Center (HGNCCC) of Iowa.

The HGNCCC is the areas only community cancer center. Its patient-centered and brings together provid-ers from various specialties to provide

TRANSFORMING THE FUTURE OF CANCER CARE

Breast cancer treatment

in half the time

Collaborative cancer care

St. Lukes is leading the way in cancer care by offering intraoperative electron radiation therapy (IOERT) for early stage breast cancer patients through an international clinical trial. IOERT combines surgery with an initial, concentrated dose of radiation precisely focused on the area where most breast cancers recur.

a comprehensive assessment and care plan for cancer patients. Rather than requiring patients to navigate the many different parts of the healthcare system, theyre instead given direct access to an entire team of local cancer

experts offering a unified treatment plan and greater continuity of service.

A multidisciplinary group of doctors provides leader-ship for the Center. There are

more than twenty medical and surgical specialties including medical oncology, general and thoracic surgery, internal medicine, primary care, radiology,

plastic surgery, pathology, urology, pul-monology and neurosurgery involved with the Community Cancer Center.

HGNCCC will relocate to the new Physicians Clinic of Iowa Medical Pavilion located in the MedQuarter Regional Medical District in April 2013.

| stlukescr.org2

~ Top 50 Heart Hospitals have higher survival rates,

shorter hospital stays, fewer readmissions and lower costs ~

~ Nationally recognized program ~

Named among the

50 best in heart care

Creating the ideal

transition home

TRANSFORMING THE FUTURE OF HEART CARE

Hospital stays can be over-whelming for patients and families this is especially true for chronic heart failure patients.

Many of these patients are newly diagnosed and unsure of the new medications, diet restrictions and well-ness choices they face. This uncertain territory can land them back in the hospital if they have difficulties manag-ing their care. With this in mind

Ranked among the Top 50 heart hospitals across the nation, the doctors, nurses and patient caregivers at St. Lukes Hospital continue to lead the battle against heart disease.

St. Lukes was recently named one of the nations Top 50 Cardiovascular Hospitals by Truven Health Analyt-ics. This year, for the first time in the studys 12 years, Truven limited the list to 50 hospitals instead of 100, to high-light providers that truly lead the way and transform heart care. This means St. Lukes is recognized for delivering higher survival rates, shorter hospital stays, fewer read-missions and lower costs. St. Lukes is the areas Heart Hospital.

St. Lukes created the Transitions Home Program for chronic heart failure patients to help them successfully navigate their return home.

St. Lukes focused on heart failure because of the high readmission rate, said Peg Bradke, St. Lukes Heart Care Services director. We looked at how we could make the patients transition home more family friendly. And in particular, we identified specific ways where there was a breakdown in

communication, which in many cases led to the patient being readmitted to the hospital.

Since the program was implemented, St. Lukes has seen a significant reduc-tion in readmissions and has even been recognized as a national model of care in articles published in The Wall Street Journal and The Washington Post.

Roy Venzon, MD, Cardiologists, L.C.

3St. Lukes Health Beat Business Edition |

A heart attack develops when an artery that supplies blood, that carries oxygen, to the heart muscle is blocked. Within minutes of a heart attack, heart tissue begins to die. Survival depends on how fast the patient gets to the hospital and how quickly they receive life-saving care.

The gold standard is to open the blocked artery within 90 minutes or less. This is called door-to-balloon time. This timetable saves lives and leads to better outcomes.

The average door-to-balloon time at St. Lukes is 59 minutes. St. Lukes fastest reported time in 2012 was 22 minutes. As you can see at St. Lukes we beat the national standard opening blocked arteries in a fraction of that time, setting a standard all our own.

At times patients may develop an infection during their stay in a hospital. Hospitals can reduce this risk by administering the proper medicines at the correct time on the same day of surgery. This measure shows how often St. Lukes administers an antibiotic before surgery to prevent infections. This is just one way St. Lukes is applying best practices for better patient care.

MRSA is an infection thats become resistant to antibotics.

Surgery

leader

Setting the standard for fast heart attack care

Eliminating infections

100999897969594939291908988

2007 2008 2009 2010 2011 2012

Pe

rcen

t of p

atie

nts

96.2

94.9

98.3

98.2

Antibiotics given before surgery

Percent of St. Lukes patients having surgery who received an antibiotic within one hour before surgery.

St. Lukes average time to open blocked arteries.

0.500.450.400.350.300.250.200.150.100.050.00

2007 2008 2009 2010 2011 2012

In

fect

ions

/100

0 Pt

. Day

s

0.11 0

.15

0.08

0

0.07

5

Reducing MRSA hospital-acquired infections

120

90

60

30

0Baseline 2007 2008 2009 2010 2011 2012

M

inut

es

109

77

67 62 62 63

Opening heart blockages faster

59

TRANSFORMING THE FUTURE OF QUALITY CARE

98.7 99

.7

0.34

0.19

Developing an infection while in the hospital is scary, but at St. Lukes we take this very seriously. In fact we want to eliminate hospital acquired infections (HAI), which can lead to readmissions and other complications.

Several years ago St. Lukes launched an initiative called Passion for Preven-tion to eradicate infections. The program raised awareness among caregivers, patients and visitors about the importance of appropriate hand washing and keeping patient areas disinfected and clean. Our efforts to prevent HAIs is seeing tremendous success.

Higher percentages are better.

Lower is better.

Lower is better.

National benchmark

| stlukescr.org6

Carl Murdock has suffered from chronic obstructive pulmonary disease (COPD) for nearly 20 years. COPD is a lung disease that makes it difficult to breathe.

Since my diagnosis I have been in and out of the hospital a lot, said Mur-dock. Id have some pain and would struggle at times to catch my breath.

Murdock and his wife, Ione, were active seniors. They loved to travel and wrote a newsletter.

It got to be too much, said Murdock. We couldnt do it all. Its unfortunate.

One thing the couple added, which has helped them navigate their new normal was palliative care. He was one of St. Lukes first palliative care patients when the inpatient palliative care program began in 2005.

I didnt know what it was, recalled Murdock. One of my doctors suggest-ed it. I was told it was not the same as hospice care. I would continue to seek ongoing treatment for my COPD.

Using palliative care doesnt mean a patient has given up living, said

4

Carl & Ione Murdock in their Marion residence.

Palliative care can be just as helpful to the family of a patient. Many baby boomers may have to care for their aging parents. Palliative care can help provide supportive services to family members who may be dealing with some painful emotional issues.

It has been great and has improved my quality of life quite a bit, said Murdock.

Matching treatment to

patient goals

TRANSFORMING THE FUTURE OF PATIENT CARE

~ Palliative care patients live

2.7 months longer than standard treatment patients ~

Source: New England Journal of Medicine

James Bell, MD, St. Lukes Hospice and Palliative Care medical director. Palliative care focuses on improving life and providing com-

fort to people with all types of serious illnesses. We work with the patient and their doctor to refocus on their priorities and care. Its about main-taining a patients quality of life.

Palliative care is appropriate at any age and at any stage in a serious ill-ness, and can be provided together with curative treatment. In fact, some patients recover and move out of palliative care. Others with chronic diseases may use it as its needed.

Managing care for some patients takes a lot of work, said Dr. Bell.

TRANSFORMING THE FUTURE OF PATIENT CARE

5

gram. These are patients that have been treated in St. Lukes ED 12 or more times during the previous year.

Many of these patients used the ED because they did not have a family doctor. Others had difficulty keeping doctors appoint-ments because they lacked transportation, had work schedules that made it tough to visit a doctor during normal business hours, or

had financial or insurance issues.

Selfridge serves as case manager for St. Lukes Emergency Department Consistent Care Program. She was able to work with Brown to help identify specialists who would be able to provide her the level of care she needed.

Working with the patients and the family doctor is really in the best interest of the patient, said Selfridge. It provides that con-sistency of care and continuous oversight.

This program has been such a huge help to me, said Brown. Things were so much harder for me before this program was implemented.

The efforts have reduced patient visits by two-thirds. During the first nine months of 2012, the original 103 EDCCP patients visited the ED 438 times compared with 1,377 visits during the same period in 2011.

We want patients to use St. Lukes ED when they have an emergency, said Selfridge. This isnt meant to keep these patients out of the ED, we just want to make sure they are getting the most appropriate and timely care.

Weekly infusion treatments have improved Theresa Browns health since she started using the Emergency Department Consistent Care Program.

St. Lukes Health Beat Business Edition |

Diagnosed with chronic obstructive pulmonary disease (COPD) just over a decade ago, every day is a struggle for Theresa Brown, 51. The Cedar Rapids woman also suffers from congestive heart failure and Gitelmans syndrome, which causes kidney problems and lowers her potassium levels.

It has been a rough several years, said Brown. I have been in and out of St. Lukes a lot. Mainly because I would get sick and couldnt breathe. It can be scary.

Brown visited St. Lukes Emergency Department (ED) 12 times in 2011. Brown and scores of other patients who were frequent users of St. Lukes ED are now receiving con-sistent care as a result of an innova-tive program at St. Lukes. Its called the Emergency Department Consis-tent Care Program (EDCCP), which

got its start thanks to a $50,000 gift from Transamerica. Its an effort to coordinate care between St. Lukes, the patients doctor, home care and mental health care.

The EDCCP program began in January 2012 with the enrollment of 103 patients, said Sallie Selfridge, St. Lukes social worker. To date, there are 233 patients in the pro-

Helping frequent ER users

lower costs, improve care

~ The efforts of the EDCCP Program have reduced patient visits by two-thirds ~

| stlukescr.org6

Critical care patients on St. Lukes intensive care unit (ICU) receive an added level of quality care thanks to a growing subspeciality of doctors called intensivists.

These doctors are critical care specialists who specialize in the management of critically ill patients. These medical specialists are full-time intensivists or critical

care doctors, who, in addition to a specialty such as pulmonary or internal medicine, have received special training

and certification in providing care to critically ill patients. Thanks to several doctors at Internists, P.C., a St. Lukes physician partner, patients admitted to St. Lukes ICU, benefit from being seen by specially trained doctors. St. Lukes was the first hospital in the area to offer an Intensivist Program.

Studies of care provided by intensivists have consistently shown improved care at reduced costs. Studies have also found because intensivists are familiar with the complications that can occur in the ICU, they are better equipped to minimize errors.

| stlukescr.org

Donald Paynter, MD, Internists, P.C.

| stlukescr.org

James Boddicker, MD, Internists, P.C.

Five percent of the population those with complex, chronic illnesses have the highest hospital readmission rates and the longest hospital stays. To improve the health for this group and help them use services more appropriately, St. Lukes developed an early intervention program using a team of health professionals called the Advanced Medical Team (AMT). This team is made up of a doctor, nurse, pharmacist, therapist, social worker and others who support a patients primary doctor. The Iowa Health System is piloting additional programs in Des Moines and Fort Dodge.

Patients are selected by a trigger tool, which identifies individuals who are requiring frequent hospitalizations, Emergency Department visits and doctors office visits. A nurse care navigator serves as the liaison between the patient and their primary doc-tor and mobilizes resources around the patient. The care navigator coaches patients,

coordinates care and implements care plans among doctors and medical specialists.

The aim is for unstable, chronically ill patients to be more satisfied with their care and expe-rience fewer hospitalizations with a decrease in the length of stay when they are hospitalized.

Improving patient outcomes in the ICU

Transforming chronic disease management

TRANSFORMING THE FUTURE OF PATIENT CARE

7 7

TRANSFORMING HEALTHCARE TODAY & BEYOND

Prescription for future

HealthcareCollaboration and care coordina-tion are the future of healthcare and St. Lukes is part of this pre-scription with the opening of the new PCI Medical Pavilion this April.

An ACO is a network of doctors and hospitals that share responsibility for providing care to patients. With the healthcare law an ACO agrees to manage all of the healthcare needs of a minimum of 5,000 Medicare patients for at least three years. These groups pool resources with the goal of trim-ming spending while boosting the quality of care. When the ACO shows its improving care and delivers it for less than the cost projected a share of the savings goes to the ACOs bottom line.

St. Lukes is part of two ACO models. One for Medicare patients and the other for privately insured patients in collaboration with Wellmark, our states largest private insurer. Today, St. Lukes is taking care of 40,000

Coordinating better healthcare

Physicians Clinic of Iowas new facility will be patient-centered and is expected to build specialty care around patients by bringing coordinated services together under one roof. Several St. Lukes services will be conveniently located in the PCI Medical Pavilion Cardiologists, L.C. and St. Lukes Breast and Bone. This move allows St. Lukes radiol-ogy technologists, sonographers, nurses and breast care coordinators to be conveniently located near PCIs oncology group and the Helen G. Nassif Community Cancer Center of Iowa.

The new facility offers more space, better parking and the ability for patients to see multiple doctors in one location on the same day.

With baby boomers entering retirement age, healthcare costs are expected to soar. Seeking ways to reduce the national deficit lawmakers looked to Medicare as one way to reduce costs. The 2010 healthcare law encouraged the development of accountable-care organizations (ACOs) as a way to improve care and reduce costs.

individuals through this partnership, which is one-third of the entire popula-tion the hospital cares for. Our goal with this program is to increase quality and access, while reducing healthcare costs.

ACOs are moving healthcare providers away from paying more for the volume of services and focusing on the quality of a patients care. As a senior affiliate of the Iowa Health System (IHS), St. Lukes has been preparing for this moment for quite some time. For years, IHS has emphasized its vision of Best Outcome for Every Patient Every Time, which is the goal of the outcome-based ACO model. The marriage between these two objectives places St. Lukes in a better position for success in delivering high quality healthcare at the lowest cost.

ACOs are networks of providers, hospitals and insurers sharing the responsibility of the cost of patient care.

The players include:

What is an ACO?

HospitalsPrivate

Practices

Doctors HealthInsurers

MultispecialtyGroup Practices

St. Lukes Health Beat Business Edition |

| stlukescr.org

TRANSFORMING HEALTHCARE TODAY & BEYOND

8 | stlukescr.org

Mary Ann Osborn, St. Lukes Chief Clinical Officer, led St. Lukes adoption of the EPIC Electronic Health Record for better patient care.

Patient charts at St. Lukes transitioned to a new, electronic health record (EHR) system this year.

EPIC is a system that advances patient safety and quality of care by providing a single, shared and secure electronic health record. Medical staff use the technology to access critical patient information

more quickly, including medical history, test results and prescriptions. St. Lukes is the first hospital in Cedar Rapids to implement this new electronic patient medical record. This is a sophisticated system that allows all of our caregivers to care for patients in a more advanced way, said Mary Ann Osborn, St. Lukes Chief Clinical Officer. Features like clinical physician support remind caregivers of patient allergies and other medical conditions, adding another level of safety and ensuring that our patients get the best possible care.

Creating a vibrant

medical communityCreating a vibrant medical community is the goal of Cedar Rapids Medical District, which was established in 2010.

It was the result of Vision Cedar Rapids 2007 and the 2009 Neighborhood Planning Process, which developed districts to grow Downtown Cedar Rapids. A Medical District is a revitaliza-tion partnership committed to promoting a dynamic urban medical community to improve the quality of life, advocate for new business and jobs in the Medical District.

The Medical District is made up of 50 square blocks and includes St. Lukes, Mercy and Physicians Clinic of Iowa.

We want to make Cedar Rapids a medical destination and attract patients to our commu-nity, said Ted Townsend, St. Lukes president and CEO. There is absolutely no reason patients should seek care outside of Cedar Rapids. We have high-quality, low-cost medical care provided by local doctors right here in Cedar Rapids.

~ Electronic health records eliminate duplicate tests, reduce medication errors and provide

easier collaboration between doctors ~

TRANSFORMING THE FUTURE OF HEALTHCARE

Transforming

patient safety

Board of Directors

Top 100 HospitalTruven Health

Top 50 Cardiovascular Hospital

Truven Health

Excellence in Nursing Magnet Award

High-performing Hospital U.S. News & World Report

Inpatient Rehabilitation Stroke Specialty Program

accreditationCommission on Accreditation of

Rehabilitation Facilities (CARF)

Womens Choice Award Best Hospitals for Patient Experience Heart Care

WomenCertified, Inc.

Gold Seal of Approval Heart failure, palliative care

and hip and knee joint replacement programs

The Joint Commission

Primary Stroke Center certified The Joint Commission

Beacon Award The American Association

of Critical Care Nurses

AdministrationTed Townsend, President & CEO

John Sheehan, Executive Vice President & Chief Operating OfficerMichelle Niermann, Vice President, Operations

Milt Aunan, Vice President, Chief Financial OfficerMary Ann Osborn, Vice President, Chief Clinical Officer

Marcia Rogers

Brian Scott, Board Chair

Jim Sealy

Dr. Richard Seitz

Drew Skogman, Secretary

Mick Starcevich

Ted Townsend, St. Lukes President & CEO

Dr. Steven Wahle

Health Care Foundation BoardLon Olejniczak

Diane Ramsey

Sarah Rheinschmidt

Paula Roby

Nancy Skogsbergh

Ted Townsend, St. Lukes President & CEO

Milt Aunan, St. Lukes CFO

St. Lukes Hospital

Leadership

Karl Cassell

Terri ChristoffersenLee Clancey

Randy Easton

Kathy Eno

Sally Gray, Chair-elect

Dr. Vic Hamre

Dr. Percy Harris

Jim Sealy, St. Lukes Health Care Foundation President

Terri Christoffersen, Chair

Shirley Holtey, Vice Chair

Steve Allsop, Immediate Past Chair

Bill Hochstetler, Secretary

Ryan Buresh, Treasurer

St. Lukes Hospital

Awards

Dr. Kenneth Anderson

Sondy Daggett

Sally Gray

Phil Hershner

Marty Hoeger

Dr. James LaMorgese

Dina Linge

Gene Neighbor

Dr. John Herring

Jim Hoffman

Dr. Keith Krewer

Chris Lindell

Kate Minette

Robin Mixdorf

Ralph Palmer

William Prowell

Amy Reasner

100 Hospitals with Great Womens Health Programs

Beckers Hospital Review

Commission on Cancer (CoC) Accreditation with commendation from

the American College of Surgeons

Chest Pain AccreditationSociety of Chest Pain Centers

IRPE Gold Award Iowa Recognition for

Performance Excellence

| stlukescr.org

2013 St. Lukes Hospital, Cedar Rapids, IA

Non Profit Org. U.S. Postage

PAID Cedar Rapids, IA

Permit No. 91

We apologize for mailing problems such as duplicate copies. If you have questions or concerns about Health Beat Business Edition, please call us at 319/369-7395 or e-mail stlukes@crstlukes.com.

1026 A Avenue NE P.O. Box 3026 Cedar Rapids, IA 52406-3026

Providing solutionsfor area businesses

830 First Ave. NECedar Rapids 319/369-7173 Hours: Mon. - Thurs.: 6:30 a.m. - 6:30 p.m. Friday: 6:30 a.m. - 5:30 p.m.

3245 Williams Parkway, SWCedar Rapids 319/861-6900 Hours: Mon. - Fri.: 10 a.m. - 4 p.m.

1795 Hwy. 64 East Anamosa 319/481-6101 Hours: Wed.: 12:30 - 3:30 p.m.

We provide drug screenings and suturing at the Work Well Clinic, which allows us to treat an injury or provide other services to get employees back on the job quickly and safely. Walk-in patients as well as appoint-ments are welcome.

In addition the Work Well Clinic makes visits to area businesses providing respiratory physi-cals, physicals, drug screenings, vaccinations and wellness screenings. The clinic has three convenient locations:

Charlie Cizio, St. Lukes Therapy Plus, senior occupational therapist with a patient.

S t. Lukes has a dedicated clinic for work-related injuries. Our experienced staff, led by board- certified occupational medicine doctors, provides physicals, workers compensation treatment and follow-up, vaccinations including flu vaccine, wellness screenings and drug testing.