#486231

Dimensions Health Corporation d/b/a Prince George’s Hospital CenterMount Washington Pediatric Hospital, Inc.

Relocation of a General Acute Care Hospital and a Special Hospital-PediatricMatter No. 13-16-2351

Responses to Second Completeness Questions Received 11/20/13

1. Regarding the response to Question #5, please provide the followingclarifications and supporting information:

A. Evidence from either the Prince George's County government or thePrince George's County Revenue Authority that documents theirplans to construct a parking garage on the proposed PGRMCmedical campus.

The County Government, or the Revenue Authority of Prince George’s County (a

quasi-public corporation), will construct the parking facility on the medical campus. The

County is working on the specifics of the financing model in order to incorporate the

project in the upcoming capital improvement program as part of the County Executive’s

Proposed FY 2015 operating and capital budgets. The County will provide the proper

documents that will show the County’s / Revenue Authority’s commitment in the March

2014 timeframe.

Dimensions has asked the County to send a letter to Dimensions, stating its

intent to build the parking facility to be completed and operational at the opening of the

proposed PGRMC. Once Dimensions receives this letter, it will forward a copy to the

Maryland Health Care Commission.

B. While your response states that the parking garage will have roomfor 1,200 parking spaces, Exhibit 29 indicates the parking deck willhave 720 spaces. Please correct or explain this apparentdiscrepancy.

The medical campus will have approximately 1,555 parking spaces to serve the

proposed PGRMC. The parking spaces would include 720 parking spaces in the

2#486231

parking facility (garage) and an additional 835 surface lot parking spaces. The

previously stated number of 1,200 parking spaces for the parking garage was an error.

These parking space numbers have been verified by HOK Architects.

2. The application states that the proposed project will be built on landdonated by Prince George's County (application, p. 13). Please disclosethe value of that land donation, and build that cost into the project cost. Inaddition, the application and additional information provided states that aparking garage is being built by the County and that "... The parkinggarage is a necessary component of the medical campus" (response tocompleteness questions, p. 5). Upon further reflection, it is MRCC staffview that the costs associated with the parking garage also requireinclusion, if PGRMC will pay rent for the garage or benefit from parking feerevenues. Will PGRMC pay rent and/or receive payments or revenue fromgarage parking fees? If the answer is yes to either, please also include thecosts of the parking garage in the project budget and any revenues andexpenses it the various versions of Table 3 that have been submitted andany that may be modified in response to these questions. Resubmit thePROJECT BUDGET to reflect the additional capital costs of land and, ifapplicable, the parking garage.

PGHC has subdivided its response into component parts:

A. Value of the land donation.

The appraised value of the Powell property (approximately 8.49 acres) ranges

from $7.5 million to $8.2 million based upon two independent appraisals of the Powell

parcel by both the County and Retail Properties of America, Incorporated.

There are no current appraisals for the other 17 acre parcel. The County

estimates that the value for the 17 acre parcel is approximately $4.5 million. The Powell

property (8.49 acres) was appraised at a higher value per acre because it has a

residential use development potential that is not available for the 17-acre parcel.

Therefore, the total 25.5 acreage site is estimated to have a value of

approximately $12,350,000.

3#486231

As requested by MHCC staff, the estimated value of the donated land is being

included in the revised Project Budget, which is attached as Exhibit 42.

B. Will PGRMC pay rent and/or receive payments or revenue from theparking fee revenues? If the answer is yes to either, please alsoinclude the costs of the parking garage in the project budget, andany revenues or expenses.

No, the County Government or the Revenue Authority of Prince George’s County

will own and operate the garage. PGRMC will be a customer. The County/Revenue

Authority will collect parking fees from the general public at an hourly rate. The County /

Revenue Authority would charge PGRMC a fixed amount for parking spaces leased by

PGRMC for employees, physicians, etc. It is anticipated that PGRMC would charge

employees (with some exemptions) for use of the parking facility to help offset the cost

of leasing spaces from the County / Revenue Authority. However, PGRMC will not

operate the garage, nor will it bear the garage’s operating expenses or receive revenue

that the garage generates.

3. With respect to the table provided in response to Question 6, pleaseprovide the following clarifications:

A. Does the reference included above in all instances refer to theDiagnostic Imaging line? If not, for each line that indicates thedepartment area is included above please specify the line thatincludes the square footage.

The existing 17,854 square footage Diagnostic Imaging Space includes existing

mammography, radiology, ultrasound, flouroscopy, CT, and nuclear medicine space. In

addition, there are 327 square feet of radiology space in the existing Emergency

Department.

4#486231

The proposed 18,702 square footage Diagnostic Imaging space includes

proposed mammography, radiology, ultrasound, flouroscopy, CT, MRI, nuclear

medicine, and bone density space.

PGHC plans an additional 2,240 SF for general radiology, 1,665 SF for CT, and

415 SF for ultrasound in the Emergency Department.

B. For bone density there is no proposed square footage or reference toanother line in the Table. Please explain or correct this omission.

The Existing Diagnostic Imaging space does not include bone density services.

The proposed bone density services space is included in the 18,702 SF proposed

diagnostic imaging space.

C. For the department area for Angiography (the 8th line) the tableindicates that the space is included above presumably in the existingand proposed departmental area for Diagnostic Imaging (seeprevious question), but for proposed capacity refers to cardiaccatheterization. However, the table specifies departmental areas forcardiac catheterization and other angiography. Please correct thereferences or explain the difference between the angiography on lineeight and the other angiography included with cardiaccatheterization. If the two references to angiography refer to twodifferent areas explain or correct the reference to cardiaccatheterization in the proposed capacity column of the firstangiography (line 8).

The “Existing Angiography” is included in the 3,939 square footage of “Existing

Cardiac Catheterization and other Angiography” category (not in the “Diagnostic

Imaging” category). The “Proposed Angiography” is included in the 9,800 square

footage of “Proposed Cardiac Catheterization and other Angiography” (not in the

“Diagnostic Imaging” category).

The revised Table appears below.

5#486231

EXISTING PROPOSED

DEPARTMENT DEPARTMENTAREAEXISTINGCAPACITY

DEPARTMENTAREA

PROPOSEDCAPACITY

Cancer Treatment – Medical 0 0 5,996 14

Cancer Treatment - Radiation Oncology 0 0 10,440 2

Diagnostic Imaging (DI) 17,854 18,702

Mammography See Note 1 1 See Note 2 2

Radiology See Note 1 2 See Note 2 3

Ultrasound See Note 1 4 See Note 2 2

Fluoroscopy See Note 1 2 See Note 2 1

Angiography See Note 3 See Note 3 See Note 4 See Note 4

Vascular lab 1,713 1 See Note 5 See Note 5

Echo / EKG / Vascular lab 1,363 4 2,944 4

EMG N/A 0 1,032 2

CT See Note 1 2 See Note 2 1

MRI Mobile 1 See Note 2 1

Nuclear Medicine See Note 1 2 See Note 2 2

Bone Density 0 0 See Note 2 1Cardiac Catheterization and otherAngiography 3,939 4 9,800 4

Dialysis (acute and chronic) 1,166 8 1,740 6

Neonatal Intensive Care 2,272 24 15,100 24Endoscopy 5,398 3 1,900 2

Note 1: Existing 17,854 square footage Diagnostic Imaging space includes ExistingMammography, Radiology, Ultrasound, Flouroscopy, CT, and Nuclear Medicine space.

Note 2: Proposed 18,702 square footage Diagnostic Imaging space includes ProposedMammography, Radiology, Ultrasound, Flouroscopy, CT, MRI, Nuclear Medicine, and BoneDensity space.

Note 3: Existing Angiography is included in the 3,939 square footage of Existing CardiacCatheterization and other Angiography.

Note 4: Proposed Angiography is included in the 9,800 square footage of Proposed CardiacCatheterization and other Angiography.

Note 5: Proposed Vascular Lab is included in the 2,944 square footage of Proposed Echo /EKG / Vascular lab. In the existing facility, the vascular lab is located in space dedicated for thelab. In the proposed facility, the vascular lab will share space with Echo / EKG.

6#486231

4. The response to question #6 appears to indicate that PGHC does notcurrently offer cancer treatment services. If this observation is incorrect,please correct the zeros under existing department area and capacity. Ifthis observation is correct, explain where the service area populationcurrently receives such services, and quantify the need for such servicesand the impact on existing service providers of the establishment of thisservice at PGRMC.

PGHC currently provides oncology (cancer) services on its campus including

surgical oncology, and medical oncology services (including infusion services on the 9th

Floor). PGHC wants to expand its complement of existing oncology services by

providing radiation therapy services. The development of radiation therapy services as

a component of PGHC’s existing oncology program would involve the purchase of

major medical equipment (linear accelerator and other support equipment), and it

would not be subject to a CON requirement. See COMAR 10.24.01.03.I(2)(d).

Dimensions’ vision is to develop a comprehensive cancer center with a full array

of diagnostic and treatment services including radiation therapy services. Dimensions’

goals include achieving Community Cancer Program (CCP) accreditation from the

American College of Surgeons. There are also plans to have discussions with

University of Maryland Medical Center’s Greenebaum Cancer Center to assess any

collaborative opportunities between the two entities. The University of Maryland

Marlene and Stewart Greenebaum Cancer Center (UMGCC) was recently named a

National Cancer Institute (NCI)-designated cancer center. A collaborative relationship

with UMMC could assist in improving local access to clinical trial programs for cancer

patients residing in Prince George’s County.

Regarding the availability of radiation therapy services, there are facilities

located in Washington D.C., Virginia, Montgomery County, and Prince George’s

7#486231

County. The facilities located in Prince George’s County that Dimensions is aware of

include the following:

1. 21st Century Oncology of Maryland: Greenbelt, Maryland

2. MedStar-RadAmerica: Joseph E. Coad Radiation Treatment Center:

Clinton, Maryland

3. Doctors Regional Cancer Center: Bowie, Maryland and Lanham, Maryland

Since radiation therapy services are generally provided on an ambulatory basis,

it is difficult to quantify how many patients seek treatment at the various locations within

and outside of Prince George’s County and therefore difficult to quantify impact. From

2007-2009, Prince George’s County averaged approximately 3,056 newly diagnosed

cancer cases per year (DHMH Tumor Registry). Oncology consultants have estimated

that approximately 45-50% of cancer patients will utilize radiation therapy services,

while approximately 25% patients may require second course of radiation treatment.

Dimensions believes that a market capture impact of 15% of cancer patients from

Prince George’s County from facilities located in Washington D.C., Virginia,

Montgomery County, and Prince George’s County should not have a significant impact

on any one facility within the region. As with other components of the proposed

PGRMC, it is the intent of Dimensions and the Prince George’s County government to

have high quality comprehensive (secondary and tertiary) medical care services

available within the County, so to make healthcare available to those Prince George’s

County residents that are currently seeking their medical care outside of Prince

George’s County.

8#486231

5. The response to Question #9 did not respond to the question with respectto the capacity of the "Pediatric ED area" and the staffing of the area. Staffalso finds that the response did not adequately explain how the unit wouldfunction. Therefore, staff requests the following information:

A. Will the observation component of the area only serve pediatricpatients? If no, please explain. If yes, will there be any otherdedicated observation beds to serve the adult patient population? Ifyes, what is the size and location of the adult observation beds? Ifno, where will adult observation patients be housed?

The observation component of the pediatric area, will serve only pediatric

patients. There will not be “dedicated” observation beds to serve observation adult

population. Adult observation patients will be cared for in the Universal Care Unit,

which will contain 68 beds.

B. Specify the number of patients that can be accommodated in thisproposed unit at any given time.

Five patients can be accommodated in this proposed unit at any given time.

Although there is one dedicated inpatient bed, all five beds will be fully equipped to be

used as either pediatric observation or pediatric inpatient beds based upon patient care

requirements. The beds will be staffed with pediatric emergency room physician and

pediatric nursing staff. If the patient has a primary care physician, care will be

collaborated with the patient’s primary care physician.

C. What has been the historical volume of pediatric ED visits andpediatric observation days? What has been the variation in thesevisits and days by day of the week and season? Submit daily censusdata, if available. Submit projections for the ED visits and pediatricobservation days following the relocation through 2021 and describethe methodology.

While the Commission defines pediatrics for the purposes of projected pediatric

inpatient beds as being between the ages of 0-14, PGHC, like many hospitals,

9#486231

classifies all minors (ages 0-17) who come into the ED as pediatric patients.1 Table 27

shows the Pediatric ED visits at PGHC by day of week and season during FY2013.

Daily census data are provided in Exhibit 43A.

Table 27ED VisitsAge 0-17

PGHCFY 2013

Sunday Monday Tuesday Wednesday Thursday Friday Saturday Grand Total

July-September 158 178 179 126 173 166 170 1,150

October-December 194 203 184 178 177 170 175 1,281

January-March 151 153 153 163 166 171 180 1,137

April-June 164 166 160 139 163 148 159 1,099

TOTAL 667 700 676 606 679 655 684 4,667

Source: PGHC

Table 28 shows the Pediatric Observation visits at PGHC by day of week and

season during FY 2013. Daily census data are provided in Exhibit 43B. As the table

shows, PGHC currently admits very few patients as observation patients. PGHC

currently does not have a pediatric hospitalist, and, consequently, nearly all pediatric

patients who need observation are referred to other facilities, most frequently,

Children’s National Medical Center (“CNMC”) in Washington, D.C. Dimensions is

currently negotiating with CNMC to provide pediatric hospitalist services at PGHC.

1 In PGHC’s bed need projections, pediatrics was defined as the Commission defines it, ages 0-14.

10#486231

Table 28Observation Visits

Age 0-17PGHC

FY 2013

Sunday Monday Tuesday Wednesday Thursday Friday Saturday TotalJuly-September 4 4 4 5 4 4 6 31October-December 5 3 3 3 8 1 5 28January-March 5 4 4 5 0 6 1 25April-June 6 3 4 2 3 2 2 22TOTAL 20 14 15 15 15 13 14 106

Source: PGHC

PGHC anticipates that the number of patients retained for observation will

increase dramatically once PGHC has a pediatric hospitalist. PGHC is working with

CNMC and others to provide the appropriate services that will enable children to be

seen near where they live, without the necessity or cost of transport.

PGHC points the Commission to the Letter of Support filed in Exhibit 18 from

Kurt Newman, MD, President and Chief Executive Officer of CNMC, which states in

relevant part:

Children's National looks forward to working in collaboration with theleadership of the new Prince George's County Regional Medical Centerto assure uninterrupted access to the highest quality of care to thechildren of the County. Specifically, Children’s National supports thedevelopment of pediatric emergency department services and pediatricshort stay beds at the regional medical center and looks forward todiscussions regarding its provision of emergency and acute care at thehospital. Children's National is dedicated to working with the new regionalmedical center, its leadership and County leadership to develop effectivecollaborations and agreements that will assure seamless delivery ofhealth care services for children by the providers of Children's National.

Projections of Pediatric Emergency visits are based on the same approach as

the projections of ED visits set forth in the CON application. The assumptions are

11#486231

straightforward and follow those in the application. Population is based on Claritas

estimates and projections. Historical visits and transport information are from internal

PGHC data.

Total Population 0-14, 2013 203,716ED Visits, PGHC, 0-14, 2013 3,638Estimated Transports, PGHC, 0-14, 2013 904Non-Transport Visits 2,734Use Rate of Non-Transport Visits/Population 0.013421Total Population, 2021 213,710Non-Transport Visits 2021 2,868Estimated Transports, 2013 9042013 Pop of Largo EMS Catchment Area 54,9332021 Pop of Largo EMS Catchment Area 55,367Pop Ratio 2021/2013 1.007891Projected Transports 911Total Projected Visits, Age 0-14 3,7792013 PGHC ED Visits, Age 15-17 1029Ratio of Age 15-17 2013 Visits/Age 0-14 Visits 0.282848Projected 2021 Visits Age 15-17 1,069Projected Total ED Visits, 2021 4,848

Currently, Pediatric observation days compose 0.5% of Pediatric ED visits. As

stated above, PGHC anticipates that this will increase dramatically when PGHC

provides Pediatric Hospitalist services.

In 2012, PGHC had 4,434 total observation days (all ages) and 52,309 ED visits.

This calculates to 8.5% of ED visits. (4,434 / 52,309 = 0.0848) At this percentage,

PGHC would expect to have 411 pediatric observation days (4,848 x 0.848 = 410.9).

However, because of overlapping stays and the need to accommodate peak periods,

PGHC has proposed four observation beds.

12#486231

D. At the bottom of page 9 you state that staffing efficiencies can begained with this model compared to the traditional inpatient model.Please quantify the staffing efficiencies that will be achieved and theresultant cost savings. Compare the planned staffing of the unit withthe staffing of the Hospital's current pediatric unit.

Recent studies in Health Affairs and supported by the Advisory Board Company

explain the efficiency of using observation units. These units can be more efficient for

providing care to certain patients and can result in shorter lengths-of-stay and lower

costs vs. admitting them to the hospital. According to one study at Brigham and

Women’s Hospital, researchers found that utilizing an observation unit could avoid

3,600 inpatient admissions per year at that hospital and save $4.6 million per year.

Based on this study, the researchers found that the overall savings to the U.S. health

care system would be $3.1 billion. However, only about one in three hospitals in the

U.S. utilizes an observation unit.

To assess the impact of more widespread observation unit use, researchers from

Brigham and Women's Hospital, Northwestern University, and Yale University reviewed

data in 16 studies to determine the average cost savings per observation unit visit.

They determined that each observation unit visit saves $1,572 compared to an inpatient

admission.

Staffing an inpatient pediatric unit requires a minimum of 4.5 paid FTEs of a

pediatric RN, a cost of approximately $350,000. This is inefficient for an ADC of 1+. By

utilizing the pediatric emergency room staff, PGHC projects that caring for the pediatric

patients in the observation room versus an inpatient unit will require only 1.5 paid FTEs

for an average of one pediatric patient per day. This results in a savings of 3.5 paid

13#486231

FTEs or approximately $233,000. Also, savings will be realized in support staff (e.g.,

Unit Clerks) as these resources will also be shared.

References:

The Advisory Board Company: Emergency Departments Save by Using Observation Units ByShane Williams, AIA, ACHA, LGB, practice area leader for design at Array Architects(04/24/2013)

Brigham and Women’s Hospital, news release, Sept. 26, 2012. Pediatric Observation Units in the US: A Systematic Review: MichelleL. Macy, MD;

Christopher S. Kim, MD; Comilla Sasson, MD; MarieM. Lozon, MD; and Matthew M.Davis,MD.

From the American Academy of Pediatrics: Pediatric Observation Units. Gregory P. Conners,MD, MPH, MBA, Sanford M. Melzer, MD, MBA, Committee On Hospital Care, and CommitteeOn pediatric Emergency medicine.

6. With respect to the response to Question #13 please provide the followingclarifications

A. The response indicates that the State contribution to the project willbe $20 million per year from FY 2014 through FY 2017 and $120million in FY 2018 for a total of $200 million. However, Exhibit 32indicates a commitment of $30 million in FY 2014 and a total of $210million. Please correct or explain this discrepancy.

Exhibit 32 shows a State capital commitment of $30,000,000 in Fiscal Year 2014

for Prince George’s Hospital System (Dimensions Healthcare System). Of the

$30,000,000 grant being provided, $20,000,000 is to be allocated for the new regional

medical center (PGRMC) project. The remaining $10,000,000 is to be allocated for

capital improvements for Laurel Regional Hospital.

B. The response also indicates that the State legislature will be asked tocommit an additional $8 million dollars to bring the total Statecommitment to $208 million. Please reconcile the need to requestaddition funding with the response to A above.

Exhibit 32 includes excerpts of the State’s capital budget plan, which shows the

State’s plan to partially fund the proposed regional medical center (PGRMC) in the

amount of $200,000,000. The FY2014 commitment for the PGRMC project is

14#486231

$20,000,000, followed by plans to provide grants of $20,000,000 in fiscal years 2015,

2016, and 2017, and a $120,000,000 grant in FY2018. The five-year State Capital

Budget prepared during the 2013 legislative session currently includes $200,000,000 for

the regional medical center project. The MOU participants will meet with State

legislators this fall to ask that an additional $8,000,000 in funding be placed in the

State’s Capital Budget to achieve the original capital funding amount agreed to be

committed by Prince George’s County and the State ($208,000,000 each). Dimensions

will keep the MHCC staff advised of its progress in obtaining an additional funding

commitment of $8,000,000 from the State.

If the additional $8,000,000 is not funded by the State, then the $8,000,000

shortfall in funds will be acquired either through a Prince George’s County community

capital campaign program and/or if necessary, additional borrowing for funds (issuance

of long-term debt).

7. Regarding Question #14, please provide information on the most recenthistory and success of Dimensions Health Corporation in (1) issuingbonds on the bond market and (2) obtaining loans from banks. Providedetails on the most recent type of bonds issued on behalf of Dimensions,including the length of the bonds and interest rate.

1994 Series Bonds

As of June 30, 2013, approximately $53.5 million of the Series 1994 Bonds

remained outstanding. These 30-year bonds were composed of two parts with interest

rates of 5.38% and 5.3%. As part of its commitment to this project, Prince George’s

County has recently assumed and paid off the remaining balance of these bonds on

behalf of the Corporation.

15#486231

Other Long Term Debt

The Corporation has had much success securing a number of capital leases,

primarily for the acquisition of equipment and other long term debt for various projects.

From 1996 through 2013 the Corporation has carried outstanding capital lease

obligations ranging from less than $1 million to $4.3 million for acquisition of various

types of equipment. Currently, the Corporation has approximately $5 million in capital

leases on its balance sheet. The table below depicts some of the more recent activities.

Year Amount Borrowed2008 $2.8 million2009 $1.0 million2011 $1.1 million2012 $1.3 million2013 $2.1 million

In 2013, the Corporation received a letter of commitment to finance $9 million, of

approximately $20 million of its intended spend on a new Electronic Medical Records

(EMR) system.

The Corporation also has trust mortgage with a balance of $3.0 million as of

June 30, 2013 with a three-year adjustable interest rate of 3.25%.

8. Regarding the response to Question #23, please provide the following:

A. The 10-year utilization forecasts from Sg2 and Milliman (summarydata should be sufficient), and explain the forecast methodology.

Below is a table from Sg2 for the years of 2013, 2018 and 2023 averaged across

the US population. The table outlines the forecasted number of discharges for the US,

total US projected population and the number of discharges per 1,000 population.

16#486231

YearProjected USDischarges

Projected USPopulation

Discharges per 1,000Population

2013 39,568,076 314,861,807 125.66807122018 39,137,520 325,322,193 120.30387362023 38,101,000 335,782,579 113.4692577

The table above illustrates a projected national ten-year decline of total

discharges of 3.7% and a projected national inpatient utilization rate decline of 9.7%.

The table below shows Sg2’s national inpatient forecast by year, illustrating

factors that are considered in their forecast model. Factors considered include the

population growth, economic factors, changes in healthcare technology, policy

formation, and changes in provision of care. Exhibit 44 is a document that goes into

more detail on Sg2’s modeling for inpatient forecasting.

In regards to Sg2’s forecasting model, the following graph shows how the

individual factors impact the projected forecast of inpatient discharges.

Sg2National Inpatient ForecastImpact Factor 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023Index 39,568,076 39,568,076 39,568,076 39,568,076 39,568,076 39,568,076 39,568,076 39,568,076 39,568,076 39,568,076 39,568,076Population 420,391 840,782 1,261,173 1,681,564 2,101,955 2,522,347 2,942,738 3,363,129 3,783,520 4,203,911Epidemiology 227,899 453,722 673,030 876,606 1,056,518 1,200,741 1,287,231 1,325,207 1,327,255 1,315,373Economy 51,142 129,087 249,666 387,261 527,176 584,209 581,680 531,231 480,164 428,483Policy 204,795 278,861 325,196 371,776 420,903 444,482 426,398 410,203 411,155 415,835Innovation and Technology -135,815 -280,739 -437,862 -609,127 -775,892 -919,361 -1,044,784 -1,169,181 -1,290,715 -1,412,04730-Day Readmissions -228,209 -468,056 -714,231 -900,138 -1,033,407 -1,143,116 -1,214,873 -1,289,961 -1,368,361 -1,446,357Potentially Avoidable Admissions -66,878 -200,157 -431,151 -766,680 -1,097,362 -1,368,320 -1,582,872 -1,726,768 -1,873,544 -2,022,210Systems of CARE -228,286 -490,145 -822,788 -1,226,180 -1,630,448 -1,964,818 -2,237,276 -2,479,372 -2,713,841 -2,950,064Grand Total 39,568,076 39,813,115 39,831,432 39,671,109 39,383,159 39,137,520 38,924,239 38,726,318 38,532,563 38,323,709 38,101,000

2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 10 YearGrowthSg2 Forecast 39,568,076 39,813,115 39,831,432 39,671,109 39,383,159 39,137,520 38,924,239 38,726,318 38,532,563 38,323,709 38,101,000 -3.7%Population-based Only 39,568,076 39,988,467 40,408,858 40,829,249 41,249,640 41,670,032 42,090,423 42,510,814 42,931,205 43,351,596 43,771,987 10.6%

17#486231

The following graph shows a 10-year trend line, as estimated by Milliman, an

actuarial firm with claims data for about half of the nation’s commercial insurers, in a

private study conducted in 2011 for Kaufman, Hall & Associates. According to Milliman,

“moderate” levels of management are likely to be more representative of aggregate best

practice for overall levels of medical service utilization, with inpatient admissions per

1,000 projected to drop from 103 in 2011 to 88 in 2021. Loosely managed healthcare

markets are expected to see declines to reach the 104 discharges per 1,000 population

utilization rate. According to Kaufman Hall & Associates, Milliman’s projected utilization

rates are exclusive of newborn discharges. The Sg2 inpatient forecasts include newborn

discharges. Therefore, anyone studying these forecasted inpatient rates needs to

recognize this difference for comparison purposes. Generally, newborn/neonatal

discharges represent approximately 9-10% of total inpatient discharges for a population

segment (Source: Sg2 forecast model). Given this assumption, the Milliman projected

moderate managed care inpatient utilization rate for 2021 would be approximately 97-98

discharges per 1,000 population.

11%3% 1%

1%-4%

-4%

-5%

-7%-4%

Pop. Epi. Policy Econ. I&T 30 DayReadm.

PAA Sys ofCARE

GrandTotal

2013 - 2023 National by Impact Factor

18#486231

Figure 5. Milliman Projections for Inpatient Use Rates for Total Population (2011-2021)

Source: Private study conducted in 2011 by Milliman for Kaufman, Hall & Associates, Inc.

Based on the national forecasts and current inpatient utilization rates of Prince

George’s County, Dimensions concluded to reduce MSGA utilization rates by

approximately 11% over the projection period. In comparison to forecasted utilization

rates by Sg2, the projected utilization rates being projected for the PGRMC service area

are significantly lower than what is being projected for national rates by Sg2. This is

illustrated below.

NationalPrince George's County Source: Sg2

2012 Total Discharges (incl. Births) 95,8502012 Total Population 891,455

2012 PG County Use Rate 107.52 125.67 (1) -14.4%

Prince George's Regional Medical Center Service Area

2018 Projected Discharges (incl. Births) 96,0942018 Projected Population 975,840

2018 PGRMC Service Area Use Rate 98.47 120.30 -18.1%

% Change -8.4% -4.3%

PG vs.Nation

(1) - 125.67 represents the 2013 National utilization rate. The PG County utilization rate isbased on 2012 data.

19#486231

Therefore Dimensions has appropriately taken into account healthcare reform,

population health management principles, and the Maryland Medicare Waiver initiative

in the development of its inpatient utilization forecasts for the PGRMC service area.

B. Specify the applicable geographic area for the admission rates,ALOS, and population shown on pages 20 through 22.

Baseline (FY2012) use rates and ALOS were calculated using FY2012 actual

data from the current (PGHC) service area by cohort (defined on pages 24-25 – Table

6). The populations shown on the bottom of page 21 for the years 2012 and 2021

represent the projected PGRMC service area by cohort (defined on pages 51-52, 85-88,

182 and Tables 7, 11, and 25).

C. Provide a detailed explanation of how the 2012 and 2013 use ratesand ALOS that appear on pages 20 and 21 were calculated.

FY2012 actual data were utilized for the PGHC current service area to calculate

use rates and ALOS by cohort. For MSGA (15-64) use rate, the calculation was 47,122

discharges in the service area / 768,254 population in the service area X 1,000 for a use

rate of 61.34/1,000 population. For MSGA (15-64) ALOS, the calculation was 21,740

total LOS for service area / 4,115 total service area cases for an ALOS of 5.28.

FY2013 ALOS and use rates were projected after the baseline FY2012 figures

were calculated. Annual changes from 2012 to 2018 were assumed based on

achievement of the Statewide ALOS, as well as achievement of initiatives in place at

PGHC during FY2013 and thereafter.

20#486231

D. Provide a more detailed explanation of how the ALOS in the table onthe top of page 21 were projected.

FY2012 actual ALOS was used as a starting point. PGHC has implemented

initiatives to decrease ALOS and has programs planned to further improve its position.

Achievement of these initiatives would place PGHC at the Statewide ALOS, which has

been reflected in the Application.

E. Please provide at least five year historical use rates and averagelengths of stay for each service comparable to the use rate andALOS reported on pages 20 and 21 including for each of the two agegroups used for MSGA volume projections.

Prince George's Hospital Center5-Year Utilization Rate History

FY2008 FY2009 FY2010 FY2011 FY2012MSGA (15-64) 68.0 69.5 66.7 64.6 61.3MSGA (65+) 309.1 310.5 304.2 304.9 283.2

Prince George's Hospital Center5-Year Average Length of Stay History

FY2008 FY2009 FY2010 FY2011 FY2012MSGA (15-64) 4.44 4.42 4.44 4.71 5.28

MSGA (65+) 6.62 6.20 6.67 6.17 6.68

F. With respect to the population, the table on the bottom of page 21reports a population 15+ of 764,050 in the first line which ispresumably for 2012. However, application page 90 reports a 2012population 15+ of 678,831. Please correct or explain the why thesenumbers are different.

764,050 represents the MSGA population in FY2012 for the PGRMC projected

service area. The 678,831 population represented a prior version of the analysis that

21#486231

did not include the addition of four zip codes to the service area that are not in Prince

George’s County. A revised table has been prepared. See Exhibit 45.

G. Identify the year represented by the projected population on line 7 ofthe table.

2021.

H. Explain how the total population on lines 1 and line 7 werecalculated. Why do the totals not equal the MSGA total column plusthe pediatric column?

The PGRMC service area zip codes were utilized for each cohort. Claritas data

(based on Census) was obtained for 2000 – 2022 by zip code. Line 1 uses the 2012

population for each zip code in the defined projected PGRMC service area by cohort.

Line 7 uses the projected 2021 population for the same defined service area.

The total column has an incorrect formula. The 892,770 represents PSY + PED

population in 2012 and the 960,166 represents PSY + PED population in 2021. The

total 2012 population should be 932,177 and the projected 2021 population should be

1,000,045. This changes the 2012 patient days per capita (total) to 0.49 (from 0.52),

and 2021 patient days per capita (total) to 0.43 (from 0.44). The revised percent

change in total patient days per capita is -13.8% (from -14.0%).

MSGA

15-64 65+ Total OB PED PSY Total

2012Projected Population 666,304 97,746 764,050 169,791 168,128 724,643 932,177AdmissionRate/1,000 61.34 283.22 62.58 20.16 5.25

Admissions 40,869 27,683 68,552 10,626 3,390 3,803

ALOS 5.28 6.68 2.83 2.63 5.45

Patient Days 215,914 184,968 400,882 30,121 8,927 20,712 460,642Patient Days perCapita 0.32 1.89 0.52 0.18 0.05 0.03 0.49

22#486231

MSGA

15-64 65+ Total OB PED PSY Total

2021Projected Population 679,026 148,524 827,550 161,617 172,495 787,672 1,000,045AdmissionRate/1,000 54.46 251.47 61.33 20.16 5.25

Admissions 36,982 37,350 74,332 9,913 3,478 4,133

ALOS 4.47 5.39 2.65 2.63 5.76

Patient Days 165,433 201,467 366,900 26,253 9,159 23,808 426,120Patient Days perCapita 0.24 1.36 0.44 0.16 0.05 0.03 0.43

% Change -24.8% -28.3% -15.5% -8.4% 0.0% 5.7% -13.8%

I. While your response cites " . . . an 11.5 decline in MSGA use ratesbetween 2012 and 2021," virtually all of that decline will have takenplace by FY 2014. Please explain how this assumption is consistentwith the State's "Waiver Proposal," which seeks reduced utilizationthrough population health measures and moving patients to lessintensive settings.

The State’s Waiver proposal is aimed at reducing the overall cost of healthcare

expense with emphasis on reducing utilization and costs associated with hospital care.

The goal would be to have the State’s inpatient utilization rates, readmission rates, and

other hospital utilization benchmarks be comparable or better than the national

averages. The inpatient forecasting model for PGRMC takes into account trends in

population health management as well as current national inpatient utilization

forecasts.

The assumptions of the inpatient forecasting model take into consideration a

number of factors including: (1) the current Prince George’s County inpatient

utilization rate in comparison to national and State inpatient utilization rates (currently

Prince George’s County has a lower inpatient utilization rate than the national

average); (2) projected increase in over-65 population for Prince George’s County

23#486231

(Prince George’s County is forecasted to have a higher growth rate of senior

population in comparison to overall State’s growth rate of the “over-65” population);

and (3) the current environment where improvements have already been made in

reducing inpatient cases (conversion of one-day inpatient stays into observation cases,

progress on reducing readmissions / avoidable admissions, etc.).

The projected inpatient utilization declines were reviewed and finalized after

reviewing national forecasts from Sg2 and Milliman. Dimensions concluded that it

would be appropriate to decrease the utilization rates in the early years of the

projection period and have stable rates in the later projection years. Dimensions

believes that the later years in the projection model will see utilization rate decline

drivers (e.g., reductions of readmission rates, reduced avoidable admissions, medical

home management initiatives, etc.) offset by the increased demands of inpatient care

driven by the increasing over-65 age population within Prince George’s County.

9. Regarding response to Question #25, please provide the followingclarifications:

A. In your response to question 25 you state: " . . . The requestreflects an increase of 7% in rates, calculated as 40% of incrementaldepreciation and interest on the new construction." What is the basisof the assumption that HSCRC will allow incremental depreciationand interest at 40%?

Historically, hospitals that qualify for an increase in rates to cover a portion of

capital costs are eligible for up to 50% of incremental capital costs. While there is no

capital project funding methodology in place today, PGHC is confident that an

appropriate rate amount will be approved. The 40% funding assumption was utilized,

which obviously reflects a lower amount than the 50% historical level.

24#486231

B. Has PGHC andlor UMMS had communication with HSCRC regardinga rate increase for the proposed project? If yes, please describe thecommunications especially as they relate to the likelihood ofreceiving approval for a rate increase under the current methodologycited in your response to Question 25 and/or alternativemethodologies.

Prior to filing its CON application, PGHC met with the HSCRC Staff and

discussed the revenue assumptions that are included in the CON application.

PGHC looks forward to working with the HSCRC Staff to develop a responsive and

effective rate structure, likely under a new waiver agreement and with modifications

to existing methodologies. It is expected that the new waiver policies will include a

newly developed capital project funding policy which could potentially include higher

rate increases for capital than included in the CON application.

10. This project assumes "repatriation" of patients from hospitals in theDistrict and in VA. With regard to that group of patients:

A. Quantify the volume that will come from such hospitals and theamount of revenue associated with that volume?

As provided in Exhibit 27 of the CON Application, 1,611 admissions are

projected to be recaptured from the District of Columbia and 178 from Virginia.

Applying PGHC’s approved FY 2013 charge per case of $14,029 would result in gross

revenue of approximately $25 million in current dollars. Outside of Maryland,

hospitals negotiate their own rates with payers, thus we are not able to estimate the

current net patient revenue associated with specific hospitals in the District of

Columbia or Virginia.

25#486231

B. How do payments by Medicare and commercial insurers differ forsimilar patients receiving care in the District vs. Maryland? Submitan estimate of the expected savings or increase in cost to Medicareand to private insurers that would result from the projectrepatriation. Explain how this estimate was developed.

Payment levels outside the State of Maryland are difficult to estimate. However,

PGHC has analyzed both AHA published national payment levels as well as previous

studies prepared in the State of Maryland comparing regulated vs. national payment

levels.

Commercial payers nationally (and assumed to be the same in the District) pay

approximately 135% of cost. In Maryland, under the HSCRC, PGHC estimates that

commercial payers pay between 110% and 115% of costs. Under these assumptions,

commercial payers are likely paying 20% less in Maryland.

Medicare would obviously pay more in Maryland than it would under the national

payment system (PPS and OPPS). While no recent computations have been

developed, based on analyses done a few years ago, the Medicare inpatient payment

difference was approximately 21%.

11. Regarding Question #30, please respond to the following:

A. Please provide a copy of the Strategic Cardiovascular Business Plandiscussed on p. 30 - 31, which includes the Market Assessment andthe Operational Assessment. Please provide the national and PrinceGeorge's County PCI and cardiac surgery utilization rates discussedon p. 30.

Copies of the Executive Summary of Dimensions’ Cardiovascular Program

Strategic Business Plan and the Market Assessment associated with the Business

Plan are attached, collectively, as Exhibit 46. The full Business Plan is not

included because it contains confidential and sensitive commercial information that

26#486231

may cause competitive harm to Dimensions and PGHC if disclosed publicly.

Dimensions believes the Executive Summary and Market Assessment provide

sufficient detail to address the Commission’s inquiry about Dimensions’ plan to

strengthen the delivery of cardiovascular services at PGHC. Also, to protect the

sensitive and confidential commercial information contained in the Executive

Summary and the Market Assessment, certain limited text was redacted, as

indicated in the documents. In addition, as indicated, several typographical errors

were corrected from the original documents, although these errors were not

material to the Dimensions Board’s consideration of the Business Plan.

In connection with the Market Assessment, PGHC calculated cardiovascular

utilization rates as set forth below:

COMPARISON OF CARDIOVASCULAR USE RATE CALCULATIONS(PER 1,000 POPULATION)

PROCEDURE /SOURCE

Claritas 2011Estimates

PrinceGeorge'sCounty

Nat'l HospitalDischargeSummary

Report2010

(Nat’l Rate)

AHA 2012Report(2009Data)

Nat’l Rate

PrinceGeorge's

County ActualExperienceRate 2010

Use RateApplied to2016 Pop.

Proj.Prince

George’sCounty

PCI 2.69 2.02 2.44 1.72 1.99

Cardiac Surgery 1.02 1.09 1.25 0.64 .87

Note: Cardiac surgery includes CABG, Valves and “other” major cardiothoracic procedures.

Prince George’s County has a lower utilization rate for cardiac surgery in

comparison to national rates. One reason may be the shortage of needed primary care

27#486231

physicians in the County, possibly causing an under-diagnosing of cardiovascular

disease and the need for procedural intervention.

B. Please provide the name of the D.C. hospitals and the number ofcardiac surgery cases performed on Prince George's Countyresidents in 2010 and more recent years, if available.

Based on hospital inpatient data of Maryland, the District of Columbia, and

Virginia, below is a table showing cardiac surgery cases of Prince George’s County

residents.

Location FY 2010 FY 2011 FY 2012D.C. Hospitals

Washington Hospital Center 244 244 236George Washington University Hospital 27 19 12Howard University Hospital 5 - -Childrens Hospital NMC 36 40 42

Total D.C. Hospitals 312 303 290Virginia Hospitals 20 12 17Total Cardiac Surgery Patients in Prince George’s County 556 543 498

C. What are the strategies and outreach efforts that PGRMC will employto rebuild confidence among local cardiologists and the communityfor the cardiac surgery program?

Dimensions’ initial strategy to rebuild confidence is to complete the

implementation of initiatives outlined in the business plan as well as the program’s

operational/infrastructure enhancement plan, which includes new cardiac surgery

leadership provided by University of Maryland, increased staffing ratios, new equipment,

additional staff training, re-vamping of patient care plans, etc. The primary focus is on

improving the overall patient and physician experience, as well as demonstrating high

quality outcomes. Operational enhancement will be an ongoing strategy.

An additional key strategy is to enhance communication and collaboration among

the cardiovascular physicians and PGHC administration.

28#486231

Additional initiatives to re-build confidence among cardiologists and the

community include:

CARDIOLOGISTS

Both formal and informal grassroots marketing activities will beimplemented to inform cardiologists of changes in the cardiac surgeryprogram. For example, one-on-one meetings will be convened to discuss(a) qualifications of new surgeon/chief of cardiac surgery; (b) thecardiologist’s preference of post-patient care involvement; and (c) level ofsatisfaction.

The chief of cardiac surgery personally will call the referring cardiologistafter each consult and surgery to discuss referred patient.

PGHC will create a collaborative Heart Team among cardiac surgery andthe cardiologists to review quality of service provided andappropriateness of care.

The cardiologists, along with the chief of cardiac surgery, will participateon PGHC CV service line steering committees, which will enhancecollaboration and communication.

Grand rounds on cardiac surgery cases and medical staff CME programswill be conducted. The cardiac surgeon will conduct 3-4 continuingeducation classes for the cardiologists. Topics will be based onpreferences of the cardiologists, as well as need determined by the chiefof cardiac surgery.

Performance dashboards for the CV program will be shared with thecardiologists.

The CV Service Line administrator personally will meet individually withthe cardiologists on a regular basis to review changes and discuss anyconcerns.

COMMUNITY

Dimensions and PGHC are in the process of finalizing a “grassroots”cardiovascular specific marketing plan to focus on education aboutcardiovascular disease signs and symptoms, when and how to accesscare, treatment options, and rehabilitation services. A CV specificspeaker’s bureau will be established and offered to communityorganizations such as churches, senior centers, Lions Club and others.During these events, information about PGHC’s cardiovascular programand physicians will be mentioned and handout material will be provided.

A formal “closed loop” cardiovascular screening program will bedeveloped in collaboration with physicians. Closed loop program refers toensuring appropriate follow-up with individuals identified to be at highrisk.

Dimensions/PGHC will continue to collaborate with Prince George’sHealth Department, University of Maryland Medical System, and otherorganizations to address the shortage of primary care physicians in the

29#486231

county, as well as improving cardiovascular and coronary heart diseasemortality rates.

Dimensions will also collaborate with local cardiologists to improveaccess to cardiology care via various strategies such as physicianrecruitment, outreach clinic development and expansion to new sites inthe county.

Dimensions will evaluate need and opportunities to have cardiologists aswell as cardiovascular surgeons see and follow-up patient visits atdesignated primary care clinics in Prince George’s County.

As the program matures and results are documented, a traditional marketingplan will be developed to promote the program to the community.

D. Organizationally, will PGRMC or the University of Maryland MedicalSystem control the administration and costs of operating the cardiacsurgery program?

The cardiac surgery program will be Dimensions’ program. Costs associated

with the program will be managed by Dimensions. However, Dimensions is currently

working very closely with the University of Maryland Medical System and University of

Maryland School of Medicine in developing an effective, high-quality cardiac surgery

program at PGHC.

Dimensions has contracted with the University of Maryland School of Medicine

(Faculty Practice Inc. / University of Maryland Surgical Associates, P.A.) to provide

cardio-thoracic surgeon resources for the cardiac surgery program. A full-time cardio-

thoracic (CT) surgeon has been recently recruited for Dimensions and will begin

performing cases at PGHC on or before April 1, 2014. This CT surgeon will also serve

as Medical Director/Chief of Cardiac Surgery for the cardiac surgery program and will

be involved in quality assurance initiatives. Three other cardio-thoracic surgeons from

University of Maryland have obtained privileges at PGHC to provide additional

coverage. In addition, the Division Chief of Cardiac Surgery at the University of

30#486231

Maryland School of Medicine is contracted by Dimensions to function as Senior

Administrator of Cardiac Surgery at PGHC.

Dimensions is currently working with the University of Maryland Medical Center

(UMMC), to arrange for UMMC to provide consultation services related to clinical staff

training, pre and post-surgical care protocols, and other support services related to the

cardiac surgery program at Dimensions. UMMC has been sharing cardiac surgery care

plans and providing training opportunities for PGHC nursing and physician extenders.

The PGHC cardiac surgery operating team will also be training with the UMMC team.

Dimensions and UMMC are in the process of finalizing a formal consultative agreement

related to additional staff training, as well as a contract for perfusion services whereby

UMMC will oversee the management of perfusion services at PGHC.

12. Regarding the response to Question #35, please provide the followingclarifications and additional information:

A. Submit clear statements of assumptions for the revenue expenseprojections submitted as Exhibits 36 and 37 especially assumptionsabout the HSCRC update factor and inflationary increases inexpenses.

Please see Exhibits 47 and 47 for assumptions for the revenue and expense

projection submitted as Exhibits 36 and 37. Specifically, all assumptions are the same

as presented in the CON application except the variable cost factor is adjusted from

85% to 50% per your request.

31#486231

B. Regarding the Patient Mix in Exhibits 36 & 37, explain the basis forthe projected increase in the percent of days and revenue fromMedicare and commercial insurance and the projected decrease inthe percentages from Medicaid.

The change in patient mix presented in Exhibits 36 and 37 is driven by the

recapture of volume. It was assumed that the recaptured volume would be 40%

Medicare and 60% Commercial insurance patients, which approximates the historical

payer mix of the targeted volumes going into D.C. and Virginia. This assumption results

in the increase in the percent of days and revenue for Medicare and commercial payers

and a resulting decrease in Medicaid volumes as compared to total patient days and

total revenue.

13. In addition your response to Question #35 states that "... if the HSCRCdecided to change to the 50 per cent variable cost factor, it would haveimplications on other assumptions including but not limited to, increasingrates through the update factor above inflation.", please respond to thefollowing:

A. Please identify what rate increase would be required to support theproject if indeed HSCRC uses the 50 variable cost factor. Also, forthe sake of gaining insight into how the assumption on variable costreimbursement affects rates, what rate increase would be required ifHSCRC used a 100 variable cost factor?

It is important to note that PGHC has been subject to an 85% variable cost

factor over recent years as volumes declined. The volumes that are projected to

increase with the opening of a new facility are intended to recapture those lost

volumes. The same 85% variability cost factor should, therefore, be applied to these

recaptured volumes.

To support the project, it is assumed PGHC needs to achieve a 1.7% operating

margin by FY 2021. To achieve the same operating margin as presented in the CON

32#486231

application, PGHC would need a 12% rate increase if the HSCRC uses the 50%

variable cost factor, and a 5% rate increase if the HSCRC uses the 100% variable cost

factor. No other assumptions were changed between the three models except for the

variable cost factor and the computed rate increase.

B. You are encouraged to present alternative projections of revenuesand expenses that include other changes beyond the variable costfactor. If you submit such an alternative, please provide it withinflation and, if possible without inflation. Submit a clear statementof assumptions such as HSCRC update factors, and projectedinflationary increases in expenses. Show how key changes inrevenues and expenses are calculated.

The model presented in the CON application is based on current methodologies

established by the HSCRC. While a new Medicare waiver agreement, if implemented,

would likely change many of the existing rate methodologies, PGHC does not wish to

speculate on what potential changes in methodology will be implemented in the future,

and therefore, does not provide alternative revenue projections at this time.

14. Regarding the response to Question #46, please provide the following:

A. Submit the calculations for Exhibit 27 columns 2, 4, 6, and 8 detailingthe impact on each hospital by zip code especially as thecalculations relate to changes in market share.

Calculations to arrive at Exhibit 27 are provided in Exhibit 49. Workbooks are

separated by cohort.

B. With respect to column 8 explain and show how the changes inmarket share by service projected in Table 13 (Application page 92)were converted to the changes in the number of discharges for eachhospital listed in Exhibit 27.

After determining change in market share by service as shown in Table 13, the

recapture assumptions were broken down further to split between DC/VA and MD

33#486231

recapture. After determining change in market share by service as shown in Table 13,

the recapture assumptions were broken down further to split between DC/VA and MD

recapture. This was done by analyzing the data on the admissions of Service Area

residents to hospitals in Washington, D.C. and the Public Health Study performed by

the University of Maryland School of Public Health, which identified outmigration as an

issue to be addressed by the establishment of a new regional medical center. PGHC

made reasonable assumptions about the ability to attract people back to Maryland

based on specialty and discussions with physicians and hospital leadership.

Discharges assumed to be recaptured from the DC/VA marketplace were spread

pro-rata based on each hospital’s current ownership of that market. Discharges

assumed to be recaptured from the MD marketplace were spread pro-rata based on

each hospital’s current ownership of that market.

For detailed calculations by cohort, refer to Exhibit 49.

C. Regarding column 6 and the relocation methodology described onApplication pages 88 and 89, please discuss why the expectedchanges in market share are so great (i.e., zip code 20716 from 6.9 to22.1 and zip code 20710 from 30.8 to 4.5) given current patientpreferences and relationships with the caregivers.

The expected changes in market share are a direct function of the Commission’s

own methodology outlined in Commissioner Barbara McLean’s proposed decision on

the CON application for the relocation of Washington Adventist Hospital (Docket No.

09-15-2295) (see Proposed Decision, pp. 157-162). The methodology is discussed in

the application on pages 84-90. Projected market shares in the new location are

determined based on relative proximity.

34#486231

EXHIBITS

42. Revised Project Budget43. A. Daily Census Data FY2013—ED Visits (Age 0-17)

B. Daily Census Data FY2013—Observation Admissions (Age 0-17)44. Sg2 Analytics Frequently Asked Questions45. Table 12 Revised ODS Analysis46. Cardiovascular Services Business Plan Executive Summary and Market Assessment47. Assumptions for revenue and expense projection in Exhibit 3648. Assumptions for revenue and expense projection in Exhibit 3749. Calculations for Exhibit 27

TABLES

27. Daily ED Visits (Age 0-17) FY 201328. Daily Observation Visits (Age 0-17) FY 2013

blrRectangle

blrRectangle

EXHIBIT 42

EXHIBIT 42REVISED PROJECT BUDGET

1. Capital Costs:a. New Construction HOSPITAL/ACC Central Utility Plant Total

(1) Building $257,572,688 $9,646,917 $267,219,605(2) Fixed Equipment (not included in construction $0(3) Land Purchase $12,350,000 $12,350,000(4) Site Preparation $23,904,693 $895,307 $24,800,000(5) Architect/Engineering Fees $17,350,181 $649,819 $18,000,000(6) Permits (Building, Utilities, Etc.) $5,397,834 $202,166 $5,600,000

SUBTOTAL $316,575,395 $11,394,210 $327,969,605

b. Renovations(1) Building(2) Fixed Equipment (not included in construction(3) Architect/Engineering Fees(4) Permits (Building, Utilities, Etc.)

SUBTOTAL $0 $0 $0

c. Other Capital Costs(1) Major Movable Equipment $107,000,000 $31,000,000 $138,000,000(2) Minor Movable Equipment $42,400,000 $42,400,000(3) Contingencies $38,555,957 $1,444,043 $40,000,000

(4)

Other (Specify) UMMS PM, Builder's Risk,Commissioning/Testing, Warehousing, Testing,Traffic Study, Davis Langdon, CM Pricing,Scheduling, Helipad, Survey, Risk Assesment,Code review, ICRA, MET Testing, CurtainwallTesting, Legal, Office Consolidation, Enabling $15,600,000 $15,600,000

SUBTOTAL $203,555,957 $32,444,043 $236,000,000

TOTAL CURRENT CAPITAL COSTS (a - c) $520,131,352 $43,838,253 $563,969,605

d. Non-Current Capital Costs(1) Inflation $26,488,323 $992,072 $27,480,395(2) Capitalized Construction Interest $46,574,555 $3,925,445 $50,500,000

TOTAL PROSOSED CAPITAL COSTS $593,194,230 $48,755,770 $641,950,000 (a - e)

2. Financing Cost and Other Cash Requirements:

a. Loan Placement Fees $6,560,758.68 $539,241.32 $7,100,000.00 b. Bond Discount c. Legal Fees (CON Related) $184,810 $15,189.90 $200,000

d. Legal Fees (Other) $92,405 $7,594.95 $100,000e. Printing

f. Consultant FeesCON Application Assistance $277,215 $22,784.84 $300,000Other (Specify) $277,215 $22,784.84 $300,000

g. Liquidation of Existing Debt h. Debt Service Reserve Fund $16,355,694 $1,344,305.83 $17,700,000 i. Principal Amortization

Reserve Fund j. Other (Specify)

TOTAL (a - j) $23,748,098 $1,951,901.69

3. Working Capital Startup Costs $109,200,000

TOTAL USES OF FUNDS (1 - 3) $726,142,328 $50,707,671.79 $776,850,000

B. Sources of Funds for Project:

1 Cash2 Pledges: Gross __________,

less allowance foruncollectables __________

3 Gifts, bequests4 Interest income (gross) $15,100,0005 Authorized Bonds $224,200,000

Bond Proceeds - Bridge Loan $128,000,000Bond Repayment with State Grants -$128,000,000

6 Mortgage7 Working capital loans8 Grants or Appropriation

(a) Federal(b) State $208,000,000(c) Local $208,000,000(c) Local (Site) $12,350,000

9 Other (Line of Credit) $109,200,000

TOTAL SOURCES OF FUNDS (1 - 9) $776,850,000

EXHIBIT 43

Exhibit 43ADaily ED Visits

PGHCAge 0-17FY 2013

Day VisitsSun. July 01, 2012 11Mon. July 02, 2012 11Tue. July 03, 2012 16Wed. July 04, 2012 12Thur. July 05, 2012 17Fri. July 06, 2012 12Sat. July 07, 2012 12Sun. July 08, 2012 10Mon. July 09, 2012 15Tue. July 10, 2012 17Wed. July 11, 2012 7Thur. July 12, 2012 10Fri. July 13, 2012 6Sat. July 14, 2012 15Sun. July 15, 2012 15Mon. July 16, 2012 11Tue. July 17, 2012 15Wed. July 18, 2012 4Thur. July 19, 2012 12Fri. July 20, 2012 15Sat. July 21, 2012 8Sun. July 22, 2012 6Mon. July 23, 2012 16Tue. July 24, 2012 17Wed. July 25, 2012 7Thur. July 26, 2012 18Fri. July 27, 2012 9Sat. July 28, 2012 16Sun. July 29, 2012 10Mon. July 30, 2012 17Tue. July 31, 2012 11Wed. August 01, 2012 9Thur. August 02, 2012 13Fri. August 03, 2012 13Sat. August 04, 2012 9Sun. August 05, 2012 9Mon. August 06, 2012 12

Day VisitsTue. August 07, 2012 11Wed. August 08, 2012 9Thur. August 09, 2012 13Fri. August 10, 2012 13Sat. August 11, 2012 8Sun. August 12, 2012 12Mon. August 13, 2012 12Tue. August 14, 2012 11Wed. August 15, 2012 5Thur. August 16, 2012 10Fri. August 17, 2012 12Sat. August 18, 2012 19Sun. August 19, 2012 12Mon. August 20, 2012 8Tue. August 21, 2012 10Wed. August 22, 2012 11Thur. August 23, 2012 6Fri. August 24, 2012 20Sat. August 25, 2012 8Sun. August 26, 2012 15Mon. August 27, 2012 12Tue. August 28, 2012 18Wed. August 29, 2012 13Thur. August 30, 2012 13Fri. August 31, 2012 18Sat. September 01, 2012 16Sun. September 02, 2012 13Mon. September 03, 2012 22Tue. September 04, 2012 15Wed. September 05, 2012 12Thur. September 06, 2012 19Fri. September 07, 2012 8Sat. September 08, 2012 17Sun. September 09, 2012 11Mon. September 10, 2012 12Tue. September 11, 2012 16Wed. September 12, 2012 7

Exhibit 43A - Daily ED Visits (Age 0-17) FY 2013

2

Day VisitsThur. September 13, 2012 19Fri. September 14, 2012 15Sat. September 15, 2012 12Sun. September 16, 2012 10Mon. September 17, 2012 18Tue. September 18, 2012 11Wed. September 19, 2012 17Thur. September 20, 2012 10Fri. September 21, 2012 15Sat. September 22, 2012 19Sun. September 23, 2012 14Mon. September 24, 2012 12Tue. September 25, 2012 11Wed. September 26, 2012 13Thur. September 27, 2012 13Fri. September 28, 2012 10Sat. September 29, 2012 11Sun. September 30, 2012 10Mon. October 01, 2012 10Tue. October 02, 2012 18Wed. October 03, 2012 12Thur. October 04, 2012 12Fri. October 05, 2012 12Sat. October 06, 2012 13Sun. October 07, 2012 10Mon. October 08, 2012 15Tue. October 09, 2012 10Wed. October 10, 2012 14Thur. October 11, 2012 12Fri. October 12, 2012 11Sat. October 13, 2012 16Sun. October 14, 2012 13Mon. October 15, 2012 12Tue. October 16, 2012 13Wed. October 17, 2012 14Thur. October 18, 2012 12Fri. October 19, 2012 12Sat. October 20, 2012 12Sun. October 21, 2012 11Mon. October 22, 2012 12Tue. October 23, 2012 16Wed. October 24, 2012 16

Day VisitsThur. October 25, 2012 13Fri. October 26, 2012 12Sat. October 27, 2012 3Sun. October 28, 2012 14Mon. October 29, 2012 7Tue. October 30, 2012 15Wed. October 31, 2012 15Thur. November 01, 2012 11Fri. November 02, 2012 16Sat. November 03, 2012 19Sun. November 04, 2012 19Mon. November 05, 2012 17Tue. November 06, 2012 11Wed. November 07, 2012 13Thur. November 08, 2012 11Fri. November 09, 2012 17Sat. November 10, 2012 11Sun. November 11, 2012 16Mon. November 12, 2012 16Tue. November 13, 2012 18Wed. November 14, 2012 9Thur. November 15, 2012 18Fri. November 16, 2012 14Sat. November 17, 2012 13Sun. November 18, 2012 10Mon. November 19, 2012 13Tue. November 20, 2012 11Wed. November 21, 2012 12Thur. November 22, 2012 10Fri. November 23, 2012 11Sat. November 24, 2012 11Sun. November 25, 2012 12Mon. November 26, 2012 16Tue. November 27, 2012 10Wed. November 28, 2012 7Thur. November 29, 2012 12Fri. November 30, 2012 14Sat. December 01, 2012 12Sun. December 02, 2012 18Mon. December 03, 2012 16Tue. December 04, 2012 15Wed. December 05, 2012 15

Exhibit 43A - Daily ED Visits (Age 0-17) FY 2013

3

Day VisitsThur. December 06, 2012 18Fri. December 07, 2012 14Sat. December 08, 2012 13Sun. December 09, 2012 22Mon. December 10, 2012 25Tue. December 11, 2012 18Wed. December 12, 2012 23Thur. December 13, 2012 14Fri. December 14, 2012 16Sat. December 15, 2012 17Sun. December 16, 2012 23Mon. December 17, 2012 23Tue. December 18, 2012 21Wed. December 19, 2012 15Thur. December 20, 2012 22Fri. December 21, 2012 14Sat. December 22, 2012 16Sun. December 23, 2012 13Mon. December 24, 2012 13Tue. December 25, 2012 8Wed. December 26, 2012 13Thur. December 27, 2012 12Fri. December 28, 2012 7Sat. December 29, 2012 19Sun. December 30, 2012 13Mon. December 31, 2012 8Tue. January 01, 2013 12Wed. January 02, 2013 20Thur. January 03, 2013 25Fri. January 04, 2013 16Sat. January 05, 2013 14Sun. January 06, 2013 9Mon. January 07, 2013 15Tue. January 08, 2013 9Wed. January 09, 2013 19Thur. January 10, 2013 14Fri. January 11, 2013 15Sat. January 12, 2013 24Sun. January 13, 2013 10Mon. January 14, 2013 17Tue. January 15, 2013 16Wed. January 16, 2013 18

Day VisitsThur. January 17, 2013 15Fri. January 18, 2013 9Sat. January 19, 2013 7Sun. January 20, 2013 16Mon. January 21, 2013 11Tue. January 22, 2013 11Wed. January 23, 2013 11Thur. January 24, 2013 11Fri. January 25, 2013 4Sat. January 26, 2013 20Sun. January 27, 2013 11Mon. January 28, 2013 7Tue. January 29, 2013 11Wed. January 30, 2013 18Thur. January 31, 2013 11Fri. February 01, 2013 10Sat. February 02, 2013 9Sun. February 03, 2013 9Mon. February 04, 2013 9Tue. February 05, 2013 13Wed. February 06, 2013 10Thur. February 07, 2013 4Fri. February 08, 2013 17Sat. February 09, 2013 12Sun. February 10, 2013 12Mon. February 11, 2013 17Tue. February 12, 2013 18Wed. February 13, 2013 19Thur. February 14, 2013 10Fri. February 15, 2013 17Sat. February 16, 2013 16Sun. February 17, 2013 13Mon. February 18, 2013 7Tue. February 19, 2013 9Wed. February 20, 2013 8Thur. February 21, 2013 19Fri. February 22, 2013 24Sat. February 23, 2013 14Sun. February 24, 2013 15Mon. February 25, 2013 15Tue. February 26, 2013 10Wed. February 27, 2013 11

Exhibit 43A - Daily ED Visits (Age 0-17) FY 2013

4

Day VisitsThur. February 28, 2013 10Fri. March 01, 2013 12Sat. March 02, 2013 18Sun. March 03, 2013 16Mon. March 04, 2013 19Tue. March 05, 2013 11Wed. March 06, 2013 8Thur. March 07, 2013 10Fri. March 08, 2013 10Sat. March 09, 2013 11Sun. March 10, 2013 10Mon. March 11, 2013 12Tue. March 12, 2013 11Wed. March 13, 2013 7Thur. March 14, 2013 9Fri. March 15, 2013 16Sat. March 16, 2013 10Sun. March 17, 2013 7Mon. March 18, 2013 16Tue. March 19, 2013 14Wed. March 20, 2013 7Thur. March 21, 2013 15Fri. March 22, 2013 12Sat. March 23, 2013 12Sun. March 24, 2013 11Mon. March 25, 2013 8Tue. March 26, 2013 8Wed. March 27, 2013 7Thur. March 28, 2013 13Fri. March 29, 2013 9Sat. March 30, 2013 13Sun. March 31, 2013 12Mon. April 01, 2013 4Tue. April 02, 2013 12Wed. April 03, 2013 10Thur. April 04, 2013 12Fri. April 05, 2013 11Sat. April 06, 2013 10Sun. April 07, 2013 17Mon. April 08, 2013 15Tue. April 09, 2013 11Wed. April 10, 2013 6

Day VisitsThur. April 11, 2013 10Fri. April 12, 2013 12Sat. April 13, 2013 18Sun. April 14, 2013 10Mon. April 15, 2013 19Tue. April 16, 2013 14Wed. April 17, 2013 18Thur. April 18, 2013 15Fri. April 19, 2013 10Sat. April 20, 2013 5Sun. April 21, 2013 5Mon. April 22, 2013 11Tue. April 23, 2013 13Wed. April 24, 2013 11Thur. April 25, 2013 11Fri. April 26, 2013 16Sat. April 27, 2013 16Sun. April 28, 2013 21Mon. April 29, 2013 15Tue. April 30, 2013 13Wed. May 01, 2013 6Thur. May 02, 2013 13Fri. May 03, 2013 15Sat. May 04, 2013 9Sun. May 05, 2013 15Mon. May 06, 2013 17Tue. May 07, 2013 16Wed. May 08, 2013 12Thur. May 09, 2013 8Fri. May 10, 2013 14Sat. May 11, 2013 18Sun. May 12, 2013 10Mon. May 13, 2013 13Tue. May 14, 2013 14Wed. May 15, 2013 11Thur. May 16, 2013 10Fri. May 17, 2013 8Sat. May 18, 2013 15Sun. May 19, 2013 15Mon. May 20, 2013 10Tue. May 21, 2013 6Wed. May 22, 2013 18

Exhibit 43A - Daily ED Visits (Age 0-17) FY 2013

5

Day VisitsThur. May 23, 2013 21Fri. May 24, 2013 11Sat. May 25, 2013 6Sun. May 26, 2013 14Mon. May 27, 2013 16Tue. May 28, 2013 16Wed. May 29, 2013 13Thur. May 30, 2013 11Fri. May 31, 2013 9Sat. June 01, 2013 7Sun. June 02, 2013 14Mon. June 03, 2013 17Tue. June 04, 2013 7Wed. June 05, 2013 5Thur. June 06, 2013 18Fri. June 07, 2013 12Sat. June 08, 2013 15Sun. June 09, 2013 7Mon. June 10, 2013 7Tue. June 11, 2013 9

Day VisitsWed. June 12, 2013 7Thur. June 13, 2013 10Fri. June 14, 2013 10Sat. June 15, 2013 21Sun. June 16, 2013 11Mon. June 17, 2013 8Tue. June 18, 2013 14Wed. June 19, 2013 16Thur. June 20, 2013 11Fri. June 21, 2013 5Sat. June 22, 2013 8Sun. June 23, 2013 13Mon. June 24, 2013 14Tue. June 25, 2013 15Wed. June 26, 2013 6Thur. June 27, 2013 13Fri. June 28, 2013 15Sat. June 29, 2013 11Sun. June 30, 2013 12Grand Total 4667

Exhibit 43BDaily Observation Admissions

PGHCAge 0-17FY 2013

Day AdmissionsSat. July 07, 2012 1Mon. July 09, 2012 1Sat. July 14, 2012 1Thur. July 19, 2012 1Fri. July 20, 2012 1Thur. July 26, 2012 1Sat. July 28, 2012 1Sun. July 29, 2012 1Wed. August 01, 2012 1Fri. August 03, 2012 1Sat. August 04, 2012 1Tue. August 07, 2012 1Mon. August 13, 2012 1Sat. August 18, 2012 1Mon. August 20, 2012 1Tue. August 21, 2012 2Fri. August 24, 2012 1Sun. August 26, 2012 1Mon. August 27, 2012 1Tue. August 28, 2012 1Wed. August 29, 2012 1Thur. August 30, 2012 1Sun. September 02, 2012 1Wed. September 05, 2012 2Sat. September 15, 2012 1Sun. September 16, 2012 1Thur. September 20, 2012 1Fri. September 21, 2012 1Wed. September 26, 2012 1Wed. October 10, 2012 1Sat. October 13, 2012 1Thur. October 18, 2012 2Thur. October 25, 2012 1Fri. October 26, 2012 1Wed. October 31, 2012 1Thur. November 01, 2012 1Mon. November 05, 2012 1

Day AdmissionsThur. November 08, 2012 1Sat. November 17, 2012 1Sun. November 18, 2012 1Mon. November 19, 2012 1Tue. November 20, 2012 1Wed. November 21, 2012 1Thur. November 22, 2012 1Sat. November 24, 2012 2Mon. November 26, 2012 1Sun. December 02, 2012 2Tue. December 04, 2012 1Thur. December 06, 2012 1Sun. December 09, 2012 2Thur. December 20, 2012 1Sat. December 22, 2012 1Tue. December 25, 2012 1Sun. January 06, 2013 1Wed. January 09, 2013 1Mon. January 14, 2013 1Fri. January 18, 2013 1Sun. January 20, 2013 1Sun. January 27, 2013 1Fri. February 08, 2013 2Sun. February 10, 2013 1Tue. February 19, 2013 2Fri. February 22, 2013 1Mon. February 25, 2013 1Fri. March 01, 2013 1Tue. March 05, 2013 1Wed. March 06, 2013 3Mon. March 11, 2013 1Wed. March 13, 2013 1Fri. March 15, 2013 1Sat. March 16, 2013 1Mon. March 18, 2013 1Tue. March 19, 2013 1Sun. March 24, 2013 1

Exhibit 43B - Daily Observation Admissions (Age 0-17) FY 2013

2

Day AdmissionsThur. April 04, 2013 1Sat. April 06, 2013 1Sun. April 07, 2013 2Tue. April 16, 2013 1Sun. April 28, 2013 1Tue. April 30, 2013 1Wed. May 01, 2013 1Thur. May 02, 2013 1Fri. May 03, 2013 1Sat. May 11, 2013 1Sun. May 19, 2013 2

Day AdmissionsTue. May 21, 2013 1Fri. May 24, 2013 1Tue. May 28, 2013 1Mon. June 03, 2013 1Wed. June 12, 2013 1Sun. June 16, 2013 1Mon. June 17, 2013 1Mon. June 24, 2013 1Thur. June 27, 2013 1

106

EXHIBIT 44

Confidential and Proprietary © 2013 Sg2 | 1.28.13 www.sg2.com

Sg2 Analytics

Frequently Asked Questions

Sg2 Analytics: 2013 Frequently Asked Questions

2 Confidential and Proprietary © 2013 Sg2 | www.sg2.com

Table of Contents

Sg2 Analytics Overview ............................................................................................................................................................ 3

Dashboards .............................................................................................................................................................................. 4

Drill-Down Analysis ................................................................................................................................................................... 7

Methodology ............................................................................................................................................................................. 9

Sg2 Analytics: 2013 Frequently Asked Questions

3 Confidential and Proprietary © 2013 Sg2 | www.sg2.com

Sg2 Analytics Overview

Q: How do Sg2 Analytics help health care organizations?

A: Sg2 Analytics help organizations prepare for the next decade in health care, examining the cumulative

effects and interdependencies of key factors driving change in utilization. Hundreds of organizations rely

on Sg2 Analytics to support service line development, program investment, innovation adoption, facility

design, performance improvement and strategic planning across the care continuum.

Q: What is the Sg2 Impact of Change® forecasting model?

A: Sg2’s Impact of Change model forecasts demand for health care services over the next decade, examining

the cumulative effects and interdependencies of key impact factors driving change in utilization. Using

both disease-based and MS-DRG–based analyses, the forecast provides a comprehensive picture of how

patients will access inpatient and outpatient services along the continuum of care.

Note: In the inpatient setting, the Systems of CARE factor includes the impact of potentially avoidable admissions

and 30-day readmissions, which can be viewed and analyzed separately from the other System of CARE impacts in

the forecast.

CARE = Clinical Alignment and Resource Effectiveness; MS-DRG = Medicare severity diagnosis-related group.

Q: How do Sg2 Analytics integrate the Impact of Change® forecasting model?

A: Unlike traditional population-based estimates, Sg2’s comprehensive forecast examines the cumulative

effects and interdependencies of the key factors that drive change in the utilization of health care services

over a 10-year period. (See the Methodology section on page 8 for more information on the Impact of

Change methodology.)

Q: What is a disease-based forecast?

A: Sg2’s disease-based forecast predicts demand for inpatient and outpatient services based on Sg2’s

proprietary CARE Group methodology. It forecasts utilization based on clinical categorizations of ICD-9

diagnosis codes called CARE Families (diseases). CARE Groups split CARE Families according to the

procedures used to treat the disease or condition. The CARE Families cut across the inpatient and

outpatient care settings so that organizations can account for how demand for services will shift between

care settings over time.

Sg2 Analytics: 2013 Frequently Asked Questions

4 Confidential and Proprietary © 2013 Sg2 | www.sg2.com

Q: What is the value of a disease-based forecast?

A: Forecasting models based solely on units of payment (eg, MS-DRGs) do not fully account for changes in

disease states and the actual delivery of care. A disease-based forecast provides a comprehensive picture

of how patients will access the health care system, including both inpatient and outpatient services, based

on the prevalence of disease. In doing so, it allows organizations to identify clinical areas in which to

invest, and informs the allocation of resources across inpatient and outpatient services. It also supports

the design of more effective marketing/business development strategies and community outreach plans.

With disease-based forecasting, Sg2 Analytics provide information that is relevant to different members of

an organization’s leadership team:

Business developers and marketing leaders know that the planning process starts with the patient. Disease-based forecasting helps business leaders to understand their market and uncover

opportunities for growth.

Clinical and service line leaders can use disease-based forecasting to predict which patients will be coming through the system, how and where they should be treated, and what services they will need.

Q: What is an MS-DRG–based forecast?

A: An MS-DRG–based forecast predicts demand for health care services based on units of payment

(Medicare severity diagnosis-related groups). Sg2’s forecasting model was originally developed using an

MS-DRG–based model for inpatient services. In 2009, Sg2 expanded its offerings to include inpatient and

outpatient disease-based forecasts that use Sg2’s proprietary CARE Group methodology. The 2012

National Demand Forecast utilizes MS-DRG Grouper v29.

CFOs and budget planners continue to use MS-DRG–based forecasts as a tool for building and managing

budgets based on quantified demand.

Q: Why measure performance across the System of CARE?

A: Health care reform suggests that hospitals and health care systems will increasingly take on more risk and

have more responsibility for managing patients’ overall health, rather than just the services they provide in

the hospital. Therefore, Sg2 has developed metrics that serve as proxies for performance for the pre-

acute, acute and post-acute care settings. These metrics are summarized in the Value Index, a unique

performance score for each Sg2 client.

Q: How do I identify opportunities for performance improvement?

A: The Organization Performance module contains dashboards that pre-calculate opportunities for

performance improvement. The intent of this reporting structure is to expedite opportunity identification

and your organization’s performance improvement process. As such, these opportunities are prioritized

from largest to smallest at the bottom portion of each dashboard page. In order to better understand how

these opportunities were calculated or to understand how to take action to achieve these opportunities,

please contact your organization’s Director of Strategic Analytics for recommendations.

Dashboards

Q: How do I export data from the dashboards to Excel?

A: From any dashboard, click on the chart or graph from which you would

like to download data. A blue box will appear around the chart or graph.

Next, hover your cursor over the export icon at the bottom of the

page and select either Data or Crosstab and then click Download.

Once the CSV file is generated, you can choose to either open or

save it.

Sg2 Analytics: 2013 Frequently Asked Questions

5 Confidential and Proprietary © 2013 Sg2 | www.sg2.com

Q: What is the difference between Data and Crosstab?

A: Exporting to Data provides you with an unformatted extract of

the data contained within a graph or table. For example, Data

provides every unique combination of measure and year.

Exporting to Crosstab maintains the basic structure of how

the data are presented within a graph or table. For example,

Crosstab provides every year with its own column.

Q: How do I export data from the dashboards to an image or PDF?

A: To export to an image or PDF, scroll down to the toolbar and click

on the export icon.

Select Image to export to a PNG file or Print to PDF to export to

a PDF and then click Download. Once the files are generated,

you can choose either to open or save them.

Q: How do I print?

A: You can print the graphs by using the print function available in your Internet browser, or by exporting to

Image or Print to PDF and using the print function within your image viewing program.

Data tables can be printed by exporting to Excel (via Data or Crosstab) and using the print function

within Excel.

Q: Can I defer a layout update in the dashboard pages? Can I do the same in the drill-downs?

A: Yes. By clicking the symbol in the toolbar at the bottom of the dashboard pages, you will defer a layout

update. This means you can make your filter selections without an immediate update to the graphs. To

update the layout, simply unselect the defer layout option. In the drill-downs, click the Defer Layout Update

button on the right side of the page. When placing fields in the filter, column and row areas, the layout will

not update until you click the Update button.

Q: In the Organization Performance module, what do the red, yellow and green colors signify?

A: Each color indicates different levels of performance, according to percentile-based categorizations. Green

indicates that performance is at or above the “leading performer” category, corresponding to the 75th

percentile or better. Yellow indicates the “standard performer” category, corresponding to performance

between the 25th and 75th percentile. Red indicates performance at or below the “lagging performer”

category, corresponding to performance below the 25th percentile.

Q: What is “Sg2 Expert Analysis”? How do I use this feature?

A: Sg2 Expert Analysis is a feature available in the National Demand Forecast module. When you see the Sg2

Expert Analysis box, you can click on the bars in the graph to the left to read Sg2 experts’ rationale behind

the forecast at the service line, CARE Family and procedure levels.

All Sg2 Expert Analyses are available in PDF format in the Analytics Support section of the online Learning

Center.

Q: How do I export the entire national forecast in the National Demand Forecast module?

A: 1. Click on the CARE Group or MS-DRG report tabs.

2. Click on the View Data table button.

3. Click on the XLS Download Full Forecast link.

Sg2 Analytics: 2013 Frequently Asked Questions

6 Confidential and Proprietary © 2013 Sg2 | www.sg2.com

Q: Can I share customized forecasts from the IoC Express module with other colleagues?

A: Yes. On the Profile page in the IoC Express module, select “Share this forecast” under the Share with your

colleagues section. You will be asked to select an organization and identify eligible colleagues.

Sg2 Analytics: 2013 Frequently Asked Questions

7 Confidential and Proprietary © 2013 Sg2 | www.sg2.com

Q: Why am I seeing this message?

A: The Sg2 Web site is optimized to work in the following Web browser versions. Please reference the links

below to update your preferred browser or contact your information technology department for further

assistance.

Internet Explorer 8 http://windows.microsoft.com/en-US/internet-explorer/downloads/ie-8

Internet Explorer 7 http://www.microsoft.com/windows/Internet-explorer/default.aspx

Firefox 3+ http://www.mozilla.com/firefox/

Safari 3+ http://www.apple.com/safari/download/

Google Chrome http://www.google.com/chrome

Drill-Down Analysis

Q: Where can I use the Defer Layout Update option in the Drill-Down Analysis?

A: The Defer Layout Update option works when using the design box on the right. When this option is

selected, you must click the Update button to refresh your view.

Q: How are cumulative percent changes calculated?

A: In the Market Demand Forecast and Organization Demand Forecast modules, percent changes are

between a given year and the base year.

Sg2 Analytics: 2013 Frequently Asked Questions

8 Confidential and Proprietary © 2013 Sg2 | www.sg2.com

Q: How do I filter results?

A: To filter data, select the button in the Viewing Pane header above the specific Row Area category. Next,

use the drop-down menu to select the dimensions you want to include/exclude in your analysis. The

button outline will appear darker for all filtered dimensions.

Q: How do I sort by dimensions and measures?

A: To sort by dimensions, right click on the name of the dimension