Slide deck I created for a group presentation on a graduate level case study based on conditions surrounding Tufts NEMC circa 2003.

1. Ford Consulting Tufts New England Medical Center Belinda Degboe, Shawn Dilmore, Caitlin Motley, Kara Vass 1

2. Overview Internal and External Environment Key Issues Strategic Alternatives Recommendation Implementation Conclusion 2

3. Current Strategy Ellen Zane 3

4. 4

5. Threats Competition Third Party Payers Uninsured Opportunities Expansion Name Recognition External Environment 5

6. Weakness Sale of Assets Poor Margin Strengths Leadership New England Quality Care Alliance (NEQCA) Internal Characteristics 6

7. Select Indicators 89.4 -54% +16% 1.72 5.79 1.68 5.5 110.7 7 Mass.gov 2008

8. Mission “We strive to heal, to comfort, to teach, to learn, and to seek the knowledge to promote health and prevent disease. Our patients and their families are at the center of everything we do. We dedicate ourselves to furthering our rich tradition of health care innovation, leadership, charity and the highest standard of care and service to all in our community.” Tufts New England Medical Center 8

10. 500,000 square feet

11. $3,000,000 investment

12. Advantages

13. Provides care conveniently to patients in community

14. Opportunity for increased market share

15. Disadvantages

16. Other area hospitals planning suburban expansions, which increases competition

17. Requires a large capital investment9 Rowland 2006

19. Standard meetings between marketing departments of NEMC and Tufts University

20. Strengthen brand to differentiate

21. Advantages

22. Leverage position in market with name recognition

23. Disadvantages

24. Loss of individual identity

25. Shared reputation

26. Difficult to quantify results

27. Cost10

29. Hire 2 full time and 2 part time hospitalists

30. $666,000 for salaries, benefits, and malpractice

31. Advantages

32. Improve efficiency

33. Improve quality

34. Cost savings

35. Incentive for PCPs and other academic physician staff

36. Disadvantages

37. Employment resistance

38. Resistance from current physician staff

39. Difficulty recruiting physicians for employed model11 Lurie and Wacher 1999. Tufts Medical Center 2008.

40. Recommendation:Two Pronged Approach 12

41. Hospitalists 1997 Study at Tufts Reimbursement structures Impact on patient care Financial effects Operating Margin 13 Gregory, Baigelman, and Wilson 2003.

42. $1.62 million added profits $185,000 plus benefits $90,000 added profit per hospitalist Hospitalist Impact 14 Gregory, Baigelman, and Wilson 2003. Laury and Wacher 1999. Merritt Hawkins 2005.

43. Marketing Current marketing efforts Strengthen brand identity Positive association with Tufts Medical School Leverage marketing and differentiate Annual Costs of $475,000 over 2 years 15 Anonymous 2009

44. Implementation Plan Responsible parties: Administration, NEMC and Tufts University Marketing & Public Relations Departments, Human Resources, Physician Board, NEQCA, & Quality Reporting

45. Year 1: Base Year

46. Year 2

47. Year 3

48. Year 4

49. Year 5

50. Communication Communication Channels: town meetings, weekly staff meetings, physician board meetings, various media 22

51. Conclusions Alignment with values Financial benefit Competitive advantage Risk 23

52. Questions 24

53. References Tufts Medical Center Website (2010). Our mission. Retrieved February 20, 2010 from http://www.tuftsmedicalce nter.org/AboutUs/OurMission Patrick, D., Murray, T., Bigby, J., & Auerbach, J. (2007). Regional Health Status Indicators Boston Massachusetts. The Commonwealth of Massachusetts Department of Public Health. Retrieved February 24, 2010 from http://www.mass.gov/?pageID=eohhs2searchlanding&sidEeohhs2&q=Regional+Health+Status+Indicators+Boston+Massachusetts&collectorName=EOHHSx Pearson Education, Inc. (2008). Per Capita Personal Income by State. Retrieved February 23, 2010 from http://www.infoplease.com/ipa/A0104652.html U.S. Department of Labor. (2006). Bureau of Labor Statistics: States with highest unemployment rates in 2005. Retrieved February 23, 2010 from http://www.bls.gov/opub/ted/2006/mar/wk1/art01.htm Division of Health Care Finance and Policy (2005). Massachusetts Uncompensated Care Pool. Retrieved February 24, 2010 from http://www.umassmed.edu/uploadedFiles/ocp/MTF/12-01-05_ucp_101.pdf Moseley, G. (2009). Managing Health Care Business Strategy. Jones and Bartlett Publishers. Sudbury, MA Patrick, D., Murray, T., Bigby, J., & Iselin, S. (2008). Health Care in Massachusetts Key Indicators. Retrieved February 24, 2010 from http://www.mass.gov/?pageID=eohhs2searchlanding&sidEeohhs2&q=Regional+Health+ Status+Indicators+Boston+Massachusetts&collectorName=EOHHSx National Conference of State Legislatures [NCSL]. (2010). Certificate of Need: State Laws and Programs. State Certificate of Need Laws 2006. Retrieved February 24, 2010 from http://www.ncsl.org/IssuesResearch/Health/ CONCertificateofNeedStateLaws/tabid/14373/Default.aspx

54. References Delmarva Foundation (2003) “Healthcare Quality Improvement and Organizational Culture” Retrieved February 23, 2010 from http://www.delmarvafoundation.org/newsAnd Publications/reports/documents/Organizational Culture. Shortell, S.M., Kaluzny, A.D.(2006) ‘Health Care Management Organizational’ Design and Behavior (5thed) Thomas Delmore learning, 5 Maxwell Drive, Clifton Park, NY. Nissan, J. (2007). NEMC, NEBH will build joint suburban facility. The Tufts Daily. Retrieved February 27, 2010 from http://www.tuftsdaily.com/2.5511/nemc-nebh-will-build-joint-suburban-facility-1.593827 Anonymous. (2006). Boston Teaching Hospitals Expand Reach into Surrounding Areas Prompting Concerns About Competition, Costs. Medical News Today. Retrieved February 21, 2010 from http://www.medicalnews today.com/articles/52798.php Rowland, C. (2006). 2 Tufts affiliates plan hospital in suburbs. Retrieved February 23, 2010 from http://www. boston.com/yourlife/health/diseases/articles/2006/09/08/2_tufts_affiliates_plan_hospital_in_the_suburbs/ Mass.gov. (2005) FY05 filing based on hospital's audited financial statements. Mass.govpdf. Retrieved February 14, 2010. MedPharma Partners, LLC. (2008). Impact of Tertiary Hospital Growth and Expansion. Massachusetts Medical Society. Retrieved on February 20, 2010 from http://www.massmed.org/AM/ Template.cfm?Section=Home6& TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=21922 MerrittHawkins(2005). Modern Healthcare Physician Compensation Review 2005 PDF. Retrieved from http://www.merritthawkins.com/pdf/2005_Modern_Healthcare_Physician_Compensation_Review.pdf ECG (2009) “AMC Financial Arrangements and Affiliations” Retrieved February 20, 2010 from http://www. ecgmc.com/services/financial_arrangements.asp Tuft University, School of medicine (2007) Retrieved on February 22, 2010 from http://www.tufts.edu/med U.S. News and World Report (2007) Retrieved on February 22, 2010 from http://gradschools.usnews.rankings andreviews.com/best-graduate-schools/top-medicalschools/items/04048 Hamilton, M. Samuel, O. (2005) “Why have AMC’s Survived?” JAMA. 2005; 293:1495-1500. Retrieved February 22, 2010 from http://jama.amaassn.org/cgi/content/abstract/293/12/1495

55. References Gregory, D., Baigelman, W., & Wilson, I. (2003). Hospital economics of the hospitalist. Health Services Research; 38(3): 905-918. Retrieved February 22, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles /PMC1360922/ Wachter, R. (1999). An Introduction to the Hospitalist Model. Annals of Internal Medicine; 130(4): 338-342. Retrieved February 20, 2010 from http://www.ncbi.nlm.nih.gov/pubmed/10068402 Hauer, K., Wachter, R., McCulloch, C., Woo, G., & Auerbach, A. (2004). Effects of hospitalist attending physicians on trainee satisfaction with teaching and with internal medicine rotations. Archives of Internal Medicine; 164(17): 1866-71. Retrieved February 21, 2010 from http://www.ncbi.nlm.nih.gov/pubmed/15451761 KruResearch. (2010). Social Media ROI for Hospitals and Health Marketers. Retrieved February 27, 2010 from http://blog.kruresearch.com/category/hospital-marketing/ Maguire, P. (2009). What's the ideal number of patients to see? Today's Hospitalist. Retrieved February 26, 2010 from http://www.todayshospitalist.com/index.php?b=articles_read&cnt=824 Tufts Medical Center. (2008). Tufts Medical Center Department of Medicine Annual Report 2008. Retrieved February 26, 2010 from http://www.tuftsmedicalcenter.org/ForHealthCareProfessionals/GraduateMedical Education/InternalMedicineResidency/DeptofMedicine/default/Tufts_Medical_Center_Dept_of_Medicine_2008_Annual_Report.pdf Lurie, J. & Wachter, R. (1999). Hospitalist Staffing Requirements. Retrieved February 26, 2010 from http://www.ncbi.nlm.nih.gov/pubmed/10538261

56. Appendix I: Exhibit of Major Systems

57. Appendix II: 5 Year Pro Forma

58. Appendix III: Key Financial Ratios

59. Appendix IV: Key Demographic Factors

60. Appendix V: Hospitalist to Patient Ratio & Salary Calculations Hospitalist to Patient Ratio Average Daily Census = Annual admissions x LOS / 365= 17,000 x 5.79/365 = 269.67 Number of hospitalists = Average Daily Census / Patients per Hospitalist + 1 to cover night shift = 269.67/10 + (1) = 28 or =269.67/15 + (1) = 18 A low estimate of 10 patients per hospitalist is used to account for the extra manpower needed for coverage during vacations and other time off. The initial recommendation for Tufts-NEMC is to average 15 patients per hospitalist. As the program progresses, Tufts-NEMC can move toward a ratio of 1:10. Therefore, Tufts-NEMC would need 18 hospitalists to cover all admissions, however, the initial recommendation is to pilot this in the Department of Medicine, which has roughly 6000 inpatient admissions, and therefore, yields the need for 7 hospitalists. Number of hospitalists = 6000 X 5.79/365 = 95.18 = 95.18/10 +1 = 10.5 = 95.18/15 + 1 = 7 Hospitalist Salary Industry research indicates the hospitalist salary at $185,000. With this as the base salary plus 20% for benefits, Tufts-NEMC will make the following investments: Year 2 – 3 hospitalist FTEs - $185,000 x 3 + ($185,000 x .20) x 3 = $666,000 Year 3 – using same formula with 4 additional hospitals FTEs = $1.5 million Year 4-5 – if disseminated throughout organization, using same formula for 18 total hospitalist FTEs = $3.9 million Data derived from xxiv, xxiii, xxv