TELLURIDE MEDICAL CENTER

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TELLURIDE MEDICAL CENTER

• STRATEGIC PLAN UPDATE

JUNE 2009
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TELLURIDE MEDICAL CENTER

• Operates two healthcare business units
• Trauma Emergency Services is a full service
  Level V Trauma Center that provides emergency
  care on a 24/7 basis
• Primary Care is a multi-specialty medical
  practice with two full-time doctors and a number
  of visiting specialists
• Has two affiliated organizations
• TMC Foundation charitable fundraising
  organization
• IFAM altitude medicine charitable research
  organization
• Provides medical services to a relatively small
  mountain resort community remotely located at an
  altitude of 8750 feet and 65 miles from the
  nearest hospital.
• Experiences seasonal fluctuations in patient
  volumes that are driven by ski season and summer
  visitors, with a peak demand during the winter
  months and a smaller spike during the summer.
• Receives tax support used to subsidize 24/7
  emergency care and provide medical safety net for
  the community.

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STRATEGY OVERVIEW

• For the past several years, TMC strategy has been
  focused on
• Providing high quality medical services
• Operating efficiently and profitably
• Expanding medical services available locally
• Developing plans for a new facility
• 2008/2009 economic recession has delayed the new
  facility.
• Local voters rejected all bonds/tax increases
  including bond for new medical facility and
  Telluride voters rejected building a medical
  center on the RV lot.
• Need for expanded emergency room still critical.
• Projected growth slowed and delayed.
• Funding new facility with grants and charitable
  giving more difficult.
• 2009 Strategic Priorities
• Continue to provide high quality medical
  services.
• Continue to operate efficiently and profitably
  despite downturn in business volume.
• Review role/mission of TMC in response to issues
  and concerns raised during past year.
• Develop plans to expand and upgrade emergency
  room facilities in the near term.
• Conduct review of health care affordability and
  medical Safety Net.
• Revise plans for new facility in response to
  November voting results and current economic
  environment.

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2009 KEY STRATEGIC ISSUES

• What is TMCs role in the community and what
  should tax dollars be used to support?
• What should be the plans for a new or improved
  facility?

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STRATEGIC ISSUE 1ROLE OF TMC

• Issues and concerns regarding TMCs role.
• Given that TMC receives tax support for 24/7
  emergency care, should TMC provide any additional
  medical services?
• Should tax money be used to subsidize additional
  medical services beyond emergency care such as
  primary care and visiting specialists?
• What is TMCs role vis-a-vis the private sector?
• Should TMC provide medical care to all patients,
  regardless of their ability to pay?
• History
• TMC was established over 30 years ago to meet
  community needs for both primary care and
  emergency care beyond those provided by a part
  time surgeon.
• THD has been a tax district for 25 years and
  voters have regularly approved supporting TMCs
  operations through taxes. While the 2002 mill
  levy increase specified the purpose was to
  support 24/7 emergency care, the 1994 mill levy
  increase did not specify a purpose and the1999
  mill levy increase was to support operating and
  maintenance expenses for TMC.

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STRATEGIC ISSUE 1ROLE OF TMC (Continued)

• TMCS Role in the Community
• Emergency Care
• TMC has been providing emergency care since its
  inception.
• Much of the tax support that TMC receives was
  specifically approved by voters to support a 24/7
  emergency care facility.
• Emergency care is the core of TMCs role.
• Primary Care
• TMC was originally established as a community
  clinic and emergency center. TMC helped to meet
  a great community need for locally available
  primary care and family oriented healthcare.
• TMC has been providing primary care in Telluride
  for over 30 years.
• Having both primary care and emergency care in
  the same facility provides operating efficiencies
  and some surge capacity for emergency care.
• While some of TMCs tax support was approved for
  general operating expenses which would include
  primary care, TMCs primary care business
  currently has a positive financial impact on TMC.
  The only tax monies that are used in primary
  care cover safety net or uninsured care expenses.
  Many of these services can be provided at a
  lower cost in the community clinic rather than in
  the emergency room.
• Serving as a source of locally available primary
  care is a key part of TMCs role.

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STRATEGIC ISSUE 1ROLE OF TMC (Continued)

• TMCS Role in the Community
• Private Sector
• TMC has served for years as a facilitator for
  expanded medical services for the community.
  Many specialized medical services have been
  provided by private medical practices working in
  conjunction with TMC.
• Many of these specialized medical services would
  not be available locally without support from a
  facility like TMC.
• The only private primary care doctor in town got
  started by originally working at TMC. His
  practice is currently enhanced by being able to
  refer patients to TMC for specific medical
  procedures that his patients would otherwise have
  to travel to Montrose to obtain.
• TMCs role is to encourage and support locally
  available private sector medical practices. Tax
  monies are not specifically used for this purpose
• Safety Net
• TMC is the only non profit medical facility in
  the local area and the only medical facility to
  receive tax support.
• TMC is currently the only Medical Safety Net for
  the community.
• TMC must provide medical care to all patients,
  regardless of their ability to pay.
• Tax support is used to cover uninsured care.

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STRATEGIC ISSUE 1ROLE OF TMC (Continued)

• Summary of TMCs Role in the Community
• TMC is dedicated to providing and supporting
  locally available, high quality medical and
  healthcare services for residents and visitors in
  the Telluride region. This is accomplished by
• Operating a Level V Trauma Center that provides
  emergency care on a 24/7 basis.
• Operating a family care practice to ensure that
  general and family practice care are available
  locally.
• Operating a community clinic to provide access to
  high quality healthcare services for those in
  need, regardless of ability to pay.
• Encouraging and supporting an increased range of
  healthcare services offered locally by a number
  of private medical practices.

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STRATEGIC ISSUE 2NEW OR IMPROVED FACILITY

• Issues
• How large of a facility does TMC really need?
• What medical services should be provided in a new
  or improved facility?
• Where can TMC find a site for a new facility?
• Are there opportunities with existing site?
• How does TMC fund a site purchase and the costs
  of building a new facility?

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STRATEGIC ISSUE 2NEW OR IMPROVED FACILITY

• Need
• Existing facility operates at capacity during
  peak season and has limited space to increase the
  volume and scope of healthcare services offered.
  
• Emergency room fills up and operates in overflow
  mode about half the time during peak periods.
• Design of existing facility is not compatible
  with good medical practices.
• Facility lacks area to receive emergency patients
  properly and has limited space for emergency
  patients.
• Facility has limited patient privacy at reception
  desk, at patient billing, and for emergency
  patients and families,
• Design does not meet current health facility
  safety standards.
• Poor facility is root cause of majority of
  negative patient feedback regarding their
  experience at TMC
• TMC badly needs a new or improved facility.

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STRATEGIC ISSUE 2NEW OR IMPROVED FACILITY
(Continued)

• Options for facility expansion
• Remodel existing facility
• Remodel would be extensive.
• Land and existing building are owned by Idarado.
• Existing site has a number of limitations
• Room to expand
• Emergency vehicle access
• Parking
• Difficult to remodel without adversely impacting
  current operations
• Build a new facility on the same site
• Same site related issues as remodeling
• Major concern would be where and how to provide
  healthcare during the two year construction
  period
• Build on a new site, either new structure or
  remodel existing structure
• Preferred option
• Most pragmatic approach from an operating
  perspective. TMC would continue operations in
  existing facility and move to new facility when
  completed.
• Biggest issue is location.

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STRATEGIC ISSUE 2NEW OR IMPROVED FACILITY
(Continued)

• 2008 Plan
• Build a new facility on the RV lot at the
  entrance to Telluride.
• Fund 50 of the cost with bonds. Provide the
  rest from charitable contributions and other
  sources.
• Plan was developed during spring and summer of
  2008, before the economic crisis.
• Outcome
• District voters rejected the bond along with all
  others during November 2008 elections.
• Telluride voters denied allowing a medical center
  to be built on the segment of the RV lot that
  belongs to the Pearl property.
• Economic crisis has made raising money through
  charitable contributions considerably more
  difficult.
• TMC currently has neither funds nor site for
  building a new facility.

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STRATEGIC ISSUE 2NEW OR IMPROVED FACILITY
(Continued)

• Current Plans
• A new facility is at least 5 years away.
  (Acquiring site, planning, funding, construction)
• Improvements to the emergency room must be made
  sooner. Only short-term option is to remodel
  existing facility. This should be done at
  minimum cost as TMC does not own the land or
  building and the site is not large enough to
  support future needs.
• Consultant will revise new facility business plan
  using updated growth projections and other
  changes that could reduce costs.
• THD will have workshop to discuss facility size
  and update site matrix.
• Next step in planning for a new or improved
  facility is finding a site.
• TMC should minimize expenses until economic
  climate improves.

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2009 Strategic Priorities and Action Plans

• Continue to provide high quality medical
  services.
• Continue to operate efficiently and profitably
  despite downturn in business volume.
• Review role/mission of TMC in response to issues
  and concerns raised during past year.
• Develop plans to expand and upgrade emergency
  room facilities in the near term.
• Conduct review of health care affordability and
  medical Safety Net.
• Revise plans for new facility.

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2009 Strategic Priorities and Action Plans

• 1. Provide high quality medical services
• Increase telemedicine.
• Implement IT strategic plan.
• Increase benefits of relationship with St. Marys.
• Increase benefits of relationship with IFAM.
• Conduct medical staff reviews of strengths and
  weaknesses of TMC capabilities and operations
  after completion of each peak season.
• Consider a community survey of the total patient
  experience with TMC.

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2009 Strategic Priorities and Action Plans
(Continued)

• 2 Operate efficiently and profitably.
• Budget for anticipated lower service volumes.
• Conduct regular and timely financial reviews of
  operating performance, taking corrective action
  as necessary.
• Examine efficiency, cost effectiveness and impact
  on patient experience of all administrative
  services.
• Identify additional opportunities for cost
  reduction.

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2009 Strategic Priorities and Action Plans
(Continued)

• 3 Review role of TMC in community.
• Conduct workshops to review and examine
• Unique public/private characteristics of TMC.
• Purpose and utilization of tax subsidy.
• Impact on core services of additional medical
  services offered at TMC.
• Perspectives of TMC stakeholders Patients,
  taxpayers, residents, staff, ski area, tourist
  businesses, construction businesses.
• What TMCs role should be regarding expanding
  medical services available locally and improving
  community wellness.
• b. Take actions to demonstrate and communicate
  the value of TMC to the community.

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2009 Strategic Priorities and Action Plans
(Continued)

• 4 Expand and upgrade emergency room.
• Develop plans to expand and upgrade emergency
  room within the existing facility to bridge the
  gap until a new facility is available.
• Goal is to increase capacity and to improve
  quality of care and overall patient experience.
• Costs need to be minimized due lack of funding
  and limited planned life for expansion/upgrade.
• Identify ways to increase peak capacity utilizing
  existing personnel and revised facilities.

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2009 Strategic Priorities and Action Plans
(Continued)

• 5 Healthcare affordability and Safety Net.
• Meet with Safety Net experts to identify best
  practices
• Identify ways to lower the costs of providing
  healthcare for the community.
• Consider ways to revise service delivery to
  patients that could provide lower costs for the
  patient. (Service delivery includes both medical
  and administrative services.)

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2009 Strategic Priorities and Action Plans
(Continued)

• 6 Revise plans for new facility.
• Conduct workshops to review and revise new
  facility business plan.
• Growth projections.
• Plans for medical services and space
  requirements.
• Funding options.
• Explore site options.
• Work with newly established fundraising
  organization to help increase their
  effectiveness.
• Continue to communicate need for new facility.