1. Summit Medical Center

2. “Top Performer” Award from The Joint Commission

3. Emergency Room Expansion – July 2011

5. Robotic Surgery: Urology and Gynecology (2011) – Thoracic Surgery and General Surgery (2012)

6. Airstrip Technologies

7. Community Benefit 2011 Charitable contributions: $170,000 Uncompensated Care: $46 million Taxes: $15.7 million Employees: 910 Salaries, Wages, and Benefits: $54 million Capital Expenditures: $12 million

8. What are some of the top “headlines” that you think of on the topic of Healthcare in the U.S.?

9. Infant Mortality – Deaths per 1,000 Live Births - 2007

10. Average Life Expectancy at Birth - 2007

11. Healthcare Costs as a % of GDP - 2007

12. Arguments in Favor of the U.S. as a Very High Quality Healthcare Provider High Healthcare Tourism: about 250,000 foreign citizens come to the U.S. annually for healthcare World’s Best Medical Education Innovation The U.S. likely reports the most accurate data – this could contribute to us looking worse by comparison Lifestyle affects health status

13. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

14. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

15. Health Concerns of Obesity  Endocrine: Diabetes, Lipid Management  Cardiovascular: Coronary Artery Disease, Heart Failure, Peripheral Vascular Disease (Amputations, By-Pass grafts), Hypertension  Neuro: Stroke  Ophthalmologic: Retinal Proliferative Disease  GI: Bariatric Surgery, Fatty Liver Disease, Steatohepatitis (complications to liver disease, pancreatic disease)  GU: Male: ED Female: Fertility, Polycystic Ovary Disease  Orthopedic: Arthritis, Hip & Knee Prosthetics, Spinal Disease  Preventive Services: Exercise, Nutrition, Weight Management  Pulmonary: Obstructive Sleep Apnea, Complications to asthma, COPD  Psychosocial: Depression  Infectious Disease: Skin Disease, Complex infection with Diabetes  Other: Complex surgical / anesthetic management, Cancer (Thyroid, Upper GI, colon, pancreas, GB, kidney, uterine, & post- menopausal breast)

16. Tobacco Consumption – Percentage of Population - 2007

17. Pharmaceutical % of Total Healthcare Costs

18. Percentage of Total Healthcare Expenditures that are Out-of-Pocket - 2007

19. Primary Care Physicians per 1,000 Population

20. What’s Next With the Affordable Care Act? Supreme Court Ruling – June ?? 2014: DSH Cuts, Insurance Exchanges, Adult No Pre-Existing, Medicaid 133% FPL, Tax on Insurance Companies 2016: Individual Penalty for no insurance of $695, or 2.5 % of taxable income 2017: Businesses with > 100 FTEs can buy from exchanges 2018: 40 % excise tax on “cadillac plans” > $10,200 for individuals, > $27,500 for families

21. Where Should Healthcare in the U.S. Be Headed? Greater use of technology for information exchange and data collection Improved quality – reduction of variance Transparency Greater proliferation of non-physician primary providers Increase in wellness and prevention in the outpatient setting Greater individual ownership of healthcare costs and decision-making

22. Questions?