1. Portsmouth Expansion Presentation Business Ad Hoc Committee

2. Why expand to Portsmouth?
ACO’s,bundled payment models
Increased revenue
Spreading overhead
Greater ability to meet the growing needs for expert quality care through certified specialists
Greater ability to be competitive with wages
More visibility
Greater ability to increase our philanthropic activities
Mission driven

3. Portsmouth Market Analysis
Population: Portsmouth, Newington, New Castle & Greenland-26,016
Median age-42.2
Median Income- $70,406
Age 55 and older 26.4%
The Portsmouth Regional Hospital positions itself as the regional expert in the following areas of care:
Primary Stroke Center
Neuroscience Center
Cancer Care
Cardiovascular Care
Maternity & Pregnancy Care-level II Care Nursery
Bone & Joint Care

4. 2010 Relevant Census Data
The biggest increase in population growth came into Hillsborough and Rockingham Counties
Percent of Population over age 65 growing with significant growth in ages while the general population growth overall is slowing.
NH is aging faster than the national average
Portsmouth area is aging faster than Strafford County
Demand for services increasing for this age group
Push to keep people aging at home
Personal care services predicted to double from

5. Competitive Market Share
Rockingham VNA & Hospice
HomeHealth VNA (Homecare & Hospice)
Portsmouth Amedysis homecare/Beacon Amedysis Hospice
Interim Health Services
Angels at Home (Out of Newburyport)

6. Private Pay services available
Interim Health Services
Home Instead
Angels at Home
Abundant Blessings
Atlantic Home Life
Living Innovations

7. Portsmouth Outreach
PRH case management meeting with Carol Early-Case Management Director
NE Rehab meeting
Meeting with Debra Grabowski, ED Foundation for Seacoast Health
Tour of Portsmouth Community Campus
Meeting with Brinn Chute, Senior Services Coordinator for city of Portsmouth

8. Outreach continued… Meeting with Ann Jamieson, CEO PRH
Meeting with Nancy Clayburgh, Portsmouth City Councilwomen
Attended Senior Center building committee
Meeting with Gerri Estes, Administrator at Clipper Harbor Langdon of Portsmouth
Service Link meeting with Becky Mae,ED
Contact with Dr Robert Lister; Senior center resource committee

9. Potential referral sources for Portsmouth area
Portsmouth Regional Hospital
Exeter Hospital
Out of area hospitals
NE Rehab
Physician offices
Community clinics

10. Continued… Clipper Harbor Langdon Edgewood Center Webster @ Rye
Durgin Pines
Oceanside Skilled Nursing and Rehab
Exeter on Hampton
Exeter
Rockingham County Nursing home
Many others on the outskirts of town-over 50

11. Expansion description
Re-arrange current space for a 3rd homecare team
Hospice and Lifecare space adequate
Depending on growth; research space available-working with Portsmouth Senior center in hopes to get space in their new center

12. Description continues…
October-training to begin for Portsmouth team Homecare and Hospice
LifeCare staffing/hiring to begin in December-usually hire for cases
Community Care-clinics starting in September
Internal hire for Portsmouth team manager
Need to train back up team manager
Computer & phone needs
Evaluate volume of services throughout the first several months the effect on other departments/finding efficiencies

13. Market Strategy
Education to current referral sources about our new service area
Increase visibility in Portsmouth Hospitals/rehabs/SNF’s & Physician offices
Community clinics
Advertising through radio, paper, business newsletters, Portsmouth Chamber events
Face to face contacts with referral sources
Connecting to senior service coordinator, senior housing authorities and Assisted Living Facilities

14. Competitive Advantage
100 years of trusted care
Current Positive relationships with Portsmouth referral sources
Differentiation- Care from birth though end of life with specialties including; WOCN, Certified Diabetic Educator, Certified Psych nurse, Certified IV nurse, Certified Lactation consultant, 60% of homecare nurses and therapists certified in chronic care management, certified palliative care & hospice nurses, palliative care consults.
Development of mental health program
Above National average in patient care satisfaction and reported patient care outcomes
Longevity of management team & staff
High staff satisfaction & low turnover

15. Barriers to consider… Limited acceptance of Medicaid & uninsured
Competitive salaries
Space & travel
Referrals not received as expected
Scale back plan
Eliminate overtime-use Portsmouth team staff on other teams
Decrease use of per diems
Not fill vacant team positions-utilize Portsmouth team staff on other teams
Utilize staff to catch up on chart audits/education
Rotate staff time off

16. Financial Assumptions
Homecare
Cornerstone will receive 25% of homecare referrals from Portsmouth Hospital for Portsmouth, Newington, New Castle, Greenland, Eliot and Kittery residents
Cornerstone will also receive referrals from physicians, skilled nursing and rehab facilities
Approximately 58% of patients will have Medicare and 42% insurance
Staffing was budgeted at a worst case scenario (staff not doing anything but being trained for 3 months)
Hospice
Assumed a small daily census of 4 to start
LifeCare
Total hours for the year average out to be 40 hours per week (this could be one case)

17. Hospital Referral Calculation
Data from American Hospital Directory
2011
Portsmouth
Discharges %
All discharges PRH
6085
by town
Total Medicare patient discharged
3531
58%
Portsmouth residents discharged (all services) with Medicare
898
25%
Kittery,Eliot,New Castle, Newington residents discharge (all services) Medicare
475 8%
Total Insurance Patients Discharged
2554
42%
% Discharged to Homecare according to data
1217
20%
Assumption that Cornerstone will obtain 25% of discharges from above
Medicare 68
Insurance 42
Cornerstone homecare referrals from hospital used in budget
110

18. Non-Hospital Referral Calculation
Cornerstone current referrals % by type
Hospital %
Hospital
636
56%
Facilities
263
23%
41%
Physicians
194
17%
31%
Other 49 4% 8%
Total
1142
PRH estimate
110
41% from Facilities 45
31% from Physicians 34
8% from Other 9
Total Other referrals used in budget 88
patients

19. Summary of Referrals Summary by quarter of patients/episodes 1st qtr
2nd qtr
3rd qtr
4th qtr
Totals
Medicare 15 25 35 40
115
Insurance 10 20 30 85
Total 45 60 70
200
Episodes = 1.17 per pt 17 29 41 47
134
Portsmouth Regional Hospital
110
Facilities
Physician Offices 34
Other 9
Total referrals for budget
198
Patients
 (Round to
200)

21. Financial Projections
Portsmouth Budget Summary by Quarter
4th qtr 2013
1st qtr 2014
2nd qtr 2014
3rd qtr 2014
4th qtr 2014
Total Budget
Revenue and Support
Medicare $
$ ,360
$ ,120
$ ,080
$ ,360
$ ,920
Medicaid $ $ $ $
Self Pay
$ ,440
$ ,715
$ ,040
$ ,145
$ ,340
Commercial Insurance
$ ,970
$ ,940
$ ,430
$ ,420
$ ,760
Total Operating Revenue
$ ,770
$ ,775
$ ,550
$ ,925
$ 1,006,020
Expenses
Total Direct Expenses
$ ,600
$ ,070
$ ,490
$ ,270
$ ,880
$ ,310
Direct Income/Loss
$ (42,600)
$ ,700
$ ,285
$ ,280
$ ,045
$ ,710 *
Administrative Costs
$ ,715
$ ,450
$ ,205
$ ,130
$ ,620
$ ,120
Total Expenses
$ ,315
$ ,520
$ ,695
$ ,400
$ ,500
$ 1,143,430
Net Income (Loss) from Operations
$ (94,315)
$ (71,750)
$ (18,920)
$ ,150
$ ,425
$ (137,410)
* $285,000 of the admin cost is overhead. This number is fixed and would be expensed to other
programs if we don't expand. Without this overhead the Net Income would be a positive $147,590

22. Homecare Budget by Quarter
Budget Portsmouth Homecare Expansion
4th qtr 2013
1st qtr 2014
2nd qtr 2014
3rd qtr 2014
4th qtr 2014
Total Budget
Comments on how each quarter was calculated
Revenue and Support
Medicare $
$ 48,960
$ 83,520
$ 118,080
$ 135,360
$ 385,920
15 / 25 / 35 / 40 patients by quarter
Medicaid $
Self Pay
Commercial Insurance
$ 14,970
$ 29,940
$ 34,430
$ 40,420
$ 119,760
10 / 20 / 25 / 30 patients
Total Operating Revenue
$ 63,930
$ 113,460
$ 152,510
$ 175,780
$ 505,680
Expenses
Wages-Nurses
$ 8,000
$ 27,600
$ 28,715
$ 31,530
$ 34,445
$ 130,290
Staffing(2) 24 hr RNs and (1) 40 hr LPN
Wages-PT
$ 8,190
$ 19,705
$ 87,010
Staffing (1) 40 hr PT
Wages-ST $ $ $ $
$ ,490
Per visit staffing
Wages-OT
$ 6,010
$ 9,530
$ 10,810
$ 47,970
Staffing (1) 24 hr OT
Wages-LNA $ $
$ 1,840
$ 2,530
$ 2,930
$ ,155
Staffing per diem
Wages-Team Manager
$ 15,765
$ 63,060
Staffed for full time
Wages - Scheduler
Staffed for 32 hours and included in a&g
Total Wages
$ 23,100
$ 73,960
$ 77,106
$ 80,720
$ 84,091
$ 338,975
Employee Benefits/Taxes
$ 4,620
$ 14,740
$ 15,425
$ 16,145
$ 16,820
$ 67,750
20% of wages
Mileage
$ 2,000
$ 2,950
$ 3,085
$ 3,230
$ 3,365
$ 14,630
Contracted Services $
$ ,200
estimated
Total Direct Expenses
$ 29,720
$ 91,950
$ 95,915
$ 100,395
$ 104,575
$ 422,555
Direct Income/Loss
$(29,720)
$ (28,020)
$ 17,545
$ 52,115
$ 71,205
$ 83,115
Wages/Benefits Admin
$ 23,000
$ 46,480
$ 48,630
$ 50,900
$ 53,020
$ 222,030
Depreciation
$ 3,725
$ 3,935
$ 4,115
$ 4,310
$ 4,490
$ 20,575
Computer Expense
$ 2,600
$ 2,755
$ 2,880
$ 3,015
$ 3,140
$ 14,390
Medical Supplies
$ 2,725
$ 2,885
$ 3,020
$ 3,160
$ 3,290
$ 15,080
Other
$ 3,350
$ 3,540
$ 3,705
$ 3,875
$ 4,040
$ 18,510
Administrative Costs
$ 35,400
$ 59,595
$ 62,350
$ 65,260
$ 67,980
$ 290,585
% of Direct expenses using current cost report method
Total Expenses
$ 65,120
$ 151,545
$ 158,265
$ 165,655
$ 172,555
$ 713,140
Net Income (Loss) from Operations
$(65,120)
$ (87,615)
$ (44,805)
$ (13,145)
$ 3,225
$(207,465)

23. Hospice Budget by Quarter
Budget Portsmouth Hospice Expansion
4th qtr 2013
1st qtr 2014
2nd qtr 2014
3rd qtr 2014
4th qtr 2014
Total Budget
Comments on how each quarter was calculated
Revenue and Support
Medicare $
$ 58,400
$ 87,600
$ 146,000
$ 438,000
Daily census of 4 / 6 /10 / 10 by qtr
Medicaid $
Self Pay
Commercial Insurance
Total Operating Revenue
Expenses
Wages-Nurses
$ 7,000
$ 7,585
$ 11,230
$ 21,420
$ 68,655
Staffing ranges from( 1) 20 hr RN up to (1) 40 hr RN & (1) on call RN
Wages-PT
Wages-ST
Wages-OT
Wages-MSW
$ 1,800
$ 1,860
$ 2,790
$ 4,755
$ 15,960
Per diem based on visits
Wages-LNA
$ 1,000
$ 2,500
$ 3,800
$ 6,390
$ 20,080
Total Wages
$ 9,800
$ 11,945
$ 17,820
$ 32,565
$ 104,695
Employee Benefits/Taxes
$ 2,080
$ 2,390
$ 3,565
$ 6,515
$ 21,065
20% of wages
Mileage
$ 1,400
$ 2,100
$ 3,500
$ 11,500
Supplies/GIP Etc
$ 8,000
$ 12,000
$ 20,000
$ 60,000
Total Direct Expenses
$ 12,880
$ 23,735
$ 35,485
$ 62,580
$ 197,260
Direct Income/Loss
$(12,880)
$ 34,665
$ 52,115
$ 83,420
$ 240,740
Wages/Benefits Admin
$ 13,000
$ 12,810
$ 18,770
$ 31,735
$ 108,050
Incl Medical Director
Depreciation
$ 1,015
$ 1,760
$ 2,685
$ ,145
Computer Expense $ $
$ 1,100
$ 1,880
$ ,260
Other $ $
$ 1,145
$ 2,415
$ ,775
Administrative Costs
$ 15,600
$ 15,425
$ 22,775
$ 38,715
$ 131,230
65 % of Direct expenses using current cost report method
Total Expenses
$ 28,480
$ 39,160
$ 58,260
$ 101,295
$ 101,296
$ 328,490
Net Income (Loss) from Operations
$(28,480)
$ 19,240
$ 29,340
$ 44,705
$ 109,510

24. Life Care Budget by Quarter
Budget Portsmouth Lifecare Expansion
4th qtr 2013
1st qtr 2014
2nd qtr 2014
3rd qtr 2014
4th qtr 2014
Total Budget
Comments on how each quarter was calculated
Revenue and Support
Medicare $ $
Medicaid
Self Pay
$ 4,440
$ 9,715
$ 18,040
$ 24,145
$ 56,340
Based on 40hrs / 88hrs / 162hrs / 218 hrs per month
Commercial Insurance
Total Operating Revenue
Expenses
Wages-Nurses
Wages-ST
Wages-OT
Wages-MSW
Wages-LNA
$ 1,295
$ 2,570
$ 4,775
$ 6,390
$ 15,030
Staffed by per diem staff based on visits
Wages-PCSP $
$ 1,285
$ 2,385
$ 3,195
$ ,455
Total Wages
$ 1,885
$ 3,855
$ 7,160
$ 9,585
$ 22,485
Employee Benefits/Taxes $ $
$ 1,075
$ 1,440
$ ,385
Mileage $
$ 1,200
$ 2,560
$ 3,200
$ ,760
Contracted Services
Total Direct Expenses
$ 2,975
$ 5,635
$ 10,795
$ 14,225
$ 33,630
Direct Income/Loss
$ 1,465
$ 4,080
$ 7,245
$ 9,920
$ 22,710
Wages/Benefits Admin
$ 1,505
$ 2,855
$ 5,475
$ 7,210
$ 17,045
Depreciation $ $ $ $
$ ,440
Computer Expense $ $ $ $
$ ,010
Other $ $ $ $
$ ,300
Administrative Costs
$ 1,835
$ 3,485
$ 6,680
$ 8,795
$ 20,795
% of Direct expenses using current cost report method
Total Expenses
$ 4,810
$ 9,120
$ 17,475
$ 23,020
$ 54,425
Net Income (Loss) from Operations
$ (370) $ $
$ 1,125
$ ,915

25. Adult Health Budget by Quarter
Budget Portsmouth Adult Health Expansion
4th qtr 2013
1st qtr 2014
2nd qtr 2014
3rd qtr 2014
4th qtr 2014
Total Budget
Comments on how each quarter was calculated
Revenue and Support
Medicare $
$ 1,000
$ 2,000
$ ,000
Flu clinic revenue
Medicaid $
Self Pay
Commercial Insurance
Total Operating Revenue
$ 4,000
$ ,000
Expenses
Wages-Nurses $
$ 1,545
$ 8,750
$ 19,885
10 hrs / 12/hrs / 24hrs / 24hrs of clinics per month
Total Wages
Employee Benefits/Taxes $ $
$ 1,750
$ ,980
20% of wages
Mileage $ $
$ ,000
Total Direct Expenses
$ 1,410
$ 2,455
$ 11,500
$ 12,500
$ 27,865
Direct Income/Loss
$ (1,410)
$ (2,455)
$ (9,500)
$ (8,500)
$ (21,865)
Wages/Benefits Admin $
$ 1,395
$ 1,245
$ 5,830
$ 6,340
$ 15,525
Depreciation $ $ $ $
$ ,195
Computer Expense $ $ $ $ $
Medical Supplies $ $ $ $
Other $ $ $ $
$ ,080
Administrative Costs
$ 1,595
$ 7,475
$ 8,130
$ 19,510
% of Direct expenses using current cost report method
Total Expenses
$ 3,005
$ 4,050
$ 18,975
$ 20,630
$ 47,375
Net Income (Loss) from Operations
$ (715)
$ (3,005)
$ (4,050)
$ (16,975)
$ (16,630)
$ (41,375)

26. Capital Budget Portsmouth Expansion
Description
Quantity
Cost per item
Total Cost
Laptops 9
$ 2,000.00
$ 18,000.00
Field licenses
$ 3,330.00
$ 29,970.00
Misc. lincensure
$ 3,800.00
Telephone Expansion 1
$ 6,000.00
Total
$ 57,700.00

27. Monitoring success
Referrals
Revenue Increases
Staff Satisfaction

28. Business Development Ad Hoc Committee Recommendations
Approved expansion plan & budget
Bring budget to finance committee
Move forward with special full board meeting to vote on 9/4/2013