Saint Joseph Hospital the LEADER. the CHOICE

Saint Joseph Hospital THE LEADER. THE CHOICE.

February 1, 1995

Stan Kamprath

Executive Director

The Helen K. and Arthur E. Johnson Foundation

1700 Broadway, Suite 2302

DenverCO80290

Dear Stan,

Thank you so much for giving Saint Joseph Hospital Foundation the opportunity to submit this proposal for setting up educational outreach communications in rural Colorado. We know that you understand the needs that small communitieshave in the area of education and are pleased to see that you want to help fill the need that is there. Weare asking the Johnson Foundation to fund this proposal for $125,000 to set up a teleconferencing program with the San Luis Valley Regional Medical Center in Alamosa, Colorado for educational outreach communications.

Saint JosephHospital already owns a dual monitor teleconferencing system capable of interactive conferencing, with our six sister hospital sites in Colorado, Kansas, Montana, and California. We are extremely excited about this new and powerful capability and have begun using it for dialogues with these areas.

We have also begun interactive Continuing Medical Education (CME) classes with our Grand Junction site and hope to expand these classes. Our acquisition and use of teleconferencing equipment illustrates our organization's firm belief in and support of these new communications strategies for educational outreach opportunities.

It will cost Saint Joseph Hospital and the San Luis Valley Regional Medical Center approximately $12,000 yearly in parttime personnel to maintain this program. This will cover the technical and scheduling, personnel for the first year. What we are asking the Johnson Foundation to fund is equipment that Saint Joseph) Hospital would own and lend to Alamosa for teleconferencing use, and the installation charge and first year of usage for the access lines between Saint Joseph Hospital and Alamosa.

We know that you understand what the future in rural outreach education is bringing in the way of interactive video conferences and hope this proposal illustrates our interest and enthusiasm as well. Thank you again for your valuable time and your commitment to educational outreach to rural Colorado. We hope you will give this proposal your fall consideration.

Sincerely,

Sister Marianna BauderRoger A. Goodwin

President and CEOExecutive Director

Saint JosephHospitalSaint JosephHospital Foundation

1835 Franklin StreetDenver802181835 Franklin StreetDenverCO80218

ENCLOSURES

(a)Summary

(b)Proposal Narrative

(1) History and Mission of Saint JosephHospital

(2) Challenges for Rural Medical and Health Education

(3)Answers through Teleconferencing Communications

(4)Future Uses

(5)Methods of Achieving Our Teleconferencing Objectives

(c)Current Boards of Directors

Saint JosephHospital Foundation

Saint JosephHospital

(d)Board and Community Support Form

(to be sent when received from The Johnson Foundation)

(e) Budgets

Foundation Operating Budget

Teleconferencing Budget and Budget Narrative

(f)Current Financial Statements

Saint JosephHospital Foundation

Saint JosephHospital

(h)Future Funding

(i)Evaluating the Teleconferencing Program

Tax exempt Status

(k)TaxExempt Status Certificate

(to be sent when received from The Johnson Foundation)

(a)SUMMARY

Saint JosephHospital is a leader in healthcare and medical education in Colorado. The Hospital currently owns equipment capable of teleconferencing with like equipment in any part of the world. While urban hospitals such as Saint JosephHospital are rich in medical education opportunities, there are currently several issues confronting medical and health education in Alamosa Colorado. The largest hurdle is the travel 6= and expense required to participate in Continuing Medical Education (CME) classes for physicians. A teleconferencing connection between Saint JosephHospital and the San Luis Valley Regional Medical Center would help ease the costs of CME and provide high quality, tailormade interactive programs from Saint JosephHospital. If grant monies are received, a teleconferencing team could be setup and equipment and services purchased, giving us a viable program within three months.

(b)PROPOSAL NARRATIVE

(1)HISTORY AND MISSION OF SAINTJOSEPHHOSPITAL

Founded in 1873, Saint JosephHospital is the oldest private hospital in Denver. It serves as a regional health center, providing a full continuum of health services ranging from preventive and primary care to, the most specialized and complicated treatments. Although the majority of patients served by the Hospital reside in the metro area, the~ Hospital also treats patients from all of Colorado as well as from neighboring states.

Since its inception, Saint JosephHospital has been dedicated to providing the very highest quality health care in a costeffective and compassionate manner. That the Hospital has achieved this goal is evidenced by studies by the Colorado Hospital Association and the Colorado Data Commission which show that for the past eleven years, the average charges at Saint JosephHospital have been the lowest of any hospital in the Denver area.

The Hospital has not sacrificed quality of care to keep its charges low. MediQual, a national medical database firm in Boston, has been analyzing clinical data from over 500 participating hospitals nationwide for the past several years. This data compares outcome or results of treatment of patients, taking into account variables such as age, severity of illness and other complications. MediQual recently designated Saint Joseph a benchmark hospital in three diagnostic areas: acute myocardial infarction, coronary artery bypass surgery, and congestive heart failure. A benchmark hospital is "one that has shown through objective data analysis to achieve the best results as compared to other hospitals" in its database.

Following are some additional highlights of Saint JosephHospital:

• Saint JosephHospital was chosen as one of the top 100 hospitals in the nation in1993 and again in 1994, according to Health Care Investment Analysts. Only 25hospitals in the U.S. have received this honor for two consecutive years. These 100hospitals charge their customers less and provide higher quality care. Saint JosephHospital has lower than average operating expenses and patients stay fewer days atSaint JosephHospital.

• As the best private, notforprofit hospital in Colorado, Saint JosephHospital hasan established reputation and tradition, with a continuous presence in thecommunity for more than 121 years.

• The Hospital is the region's busiest. It has the highest average occupancy and thegreatest number of admissions. Saint JosephHospital cares for one out of everyseven hospital patients in Denver.

• Saint JosephHospital performs the greatest number of surgeries in the Denver area -- over 18,000 in 1993.

• Saint JosephHospital is a regional health care center, caring for patients from throughout Colorado as well as from out of state. The Hospital's rural care network serves 23 rural communities throughout Colorado, Nebraska, Kansas and Wyoming.

• Saint JosephHospital has the busiest maternal/baby unit of any hospital in the state. Approximately one in ten babies born Colorado begins its life at Saint JosephHospital,, and one out of every five babies born in Denver is born here. As many as one out of every eight of these newborns requires care in the Hospital's Neonatal Intensive Care Unit. This new facility, opened in July 1994, houses up to 38 neonatal infants, the largest and most uptodate facility in the Rocky Mountain Region.

• Caring for those in need has been a mission of Saint JosephHospital since its founding in 1873, 121 years ago. Saint JosephHospital provided approximately $2.9 million of charity care in fiscal 1994 as well as forgiving $1.8 million in uncollected accounts. The Saint Joseph Hospital Foundation spent $144,920 on indigent care programs sponsored by the Hospital. The Hospital also had an additional $7.031 million of charges uncollected under the terms of governmental indigent programs. The bulk of the Hospital's charity care is provided through the Hospital's clinics.

In addition to providing only the highest quality, costeffective care, Saint JosephHospital boasts of being the largest private nonuniversity medical educational facility in the RockyMountain region. Following are some of the programs and accomplishments of these programs.

• The cornerstone of the Hospital's educational activity is its Graduate Medical Education Program. In fact, the*'Hospital has celebrated its 102nd year as a graduate teaching facility. Since the time the Hospital's first resident physician took his position with the Hospital in January 1893, the program has grown to 109 residents in training in Dentistry, Family Practice, Internal Medicine, Obstetrics and Gynecology, and Surgery. This is more than two times the number of programsin other private teaching hospitals in the state. These teaching programs involve numerous conferences and lectures.

• The Hospital also offers numerous Continuing Medical Education classes for practicing physicians, nurses and other healthcare professionals who must continually update their professional skills. For example, the Hospital sponsors Current Clinical Updates seminars which provide the most uptodate information on medical techniques and practice for physicians. In 1993 119 physicians attended four Updates. These programs especially benefit those living in rural and outlying areas who may not otherwise have easy access to educational opportunities. The May 1994 Update became the first live, interactive teleconference to originate from Saint JosephHospital using its new teleconferencing equipment.

• The Hospital also sponsors several educational program for the community. Themajority of these are organized by The Women's Pavilion and by the SAGE senior healthcare program of the FamilyPracticeCenter. During fiscal year 1993 The Women's Pavilion sponsored 306 educational programs in the areas of prenatal care, parenting and women's health education. These classes were attended by 6,568individuals.

Many of these educational programs could be brought to Colorado's rural communities through the use of teleconferencing equipment. We hope to show you the value of this new educational toot that allows remote locations to become involved in the educational programs of an urban hospital.

(2) CHALLENGES FOR RURAL MEEDICAL AND HEALTH EDUCATION

Alamosa Colorado is located in the SanLuisValley of southcentral Colorado. The nearest large town, Colorado Springs, is 160 driving miles (over a major mountain range) away. The Valley is, as you can tell, rather isolated. The current health center serves the entire population of the Valley which includes several smaller outlying towns. The total population that the San Luis Valley Regional Medical Center serves is over 40,000 people. There are approximately 250 deliveries yearly, many of which are high risk mothers and babies. Currently the San Luis Valley Medical Center staffs 35 physicians in various specialty areas including general surgery, pediatrics, family practice, OB/GYN, internal medicine, orthopedics, and urology. The hospital houses 85 beds. Alamosa is a typical rural community represented by a large number of specialty physicians who are isolated from major cities, technologically advanced equipment, and uptodate information.

The issues confronting medical and health education in Alamosa are similar to many small Colorado towns. Following is a discussion of some of these issues that we hope to address with our teleconferencing program at Saint JosephHospital:

• The current educational lineup in Alamosa includes a weekly program Septemberthrough May. The topics include Safety Education in the Work Place, Basic LifeSupport, Advanced Life Support, diabetes, and other basic medical education.Although these basic courses fulfill requirements for some of the newer staff,including some of the nursing staff, not many of these classes discuss the moretechnologically advanced discoveries and theories that urban physicians have access to. The more specialized educational programs such as pediatric orthopedics,pediatric oncology, and others don't often come to rural areas such as Alamosa. Withseveral medical specialties represented in the Valley there is a correspondingly lownumber of specialty education classes offered. There is a real lack of pertinent, lifeassisting medical ~formation flowing into the SanLuisValley.

• Approximately 60% of the Continuing Medical Education (CME) programs involve someone from the larger towns such as Colorado Springs traveling to Alamosa to givethe presentation. Over the course of a year this costs either the SanLuis ValleyRegional MedicalCenter or the educator over $10,000 for travel and the facilitator'stime. Although this does ensure more uptodate specialty information, it is costly inboth time and money.

• AMA Category One CME credits are required by many states for physician licensure,as well as by many specialty medical societies for recertification and by medical staffsfor membership. Most physicians need to have some CIME credits for licensure, recertification, or memberships. Every medical specialty is different in theirrequirements. For example, Family Practitioners must attain 150 credit hours everythree years to remain certified. Each physician chooses to fulfill these hours in avariety of different ways. Some physicians may attend four, weeklong conferencesover the course of three years in other regions of the U.S. at a cost of $700 fortuition, $700 for hotel accommodations and meals, $600 for airfare. This totals$2,000 for 40 credit hours. For a full three year certification a physician could spendas much as $8,000 on travel and tuition.

Other physicians may choose the more economical approach of reading journal articles and taking tests on a yearly basis. Still others may attend hourlong CME luncheons offered by the hospital, if they are appropriate to their specialty. On average in Alamosa, staff physicians spend $2,000 and one week off per year for CME. The grand total that this costs the physicians in the Valley is $70,000 per year. A week away from the office costs the physician at least $1,000 in lost wage time. This again when multiplied by the 35 physicians in the area costs the Valley's medical staff another $35,000 for CNE, for a total of $105,000 per year spent on CME in the San Luis Valley.

This is an expense that can of course be lowered through more easily accessible CME classes for Alamosa physicians. In speaking with rural physicians, CME classes are one of their major requests.

• Many physicians also learn a great deal from watching and consulting with otherdoctors in their own specialty area in an educational exchange. But often if a patienthas symptoms that cannot be diagnosed in the Valley, the patient is sent to a largercity where there are more specialists to consult. The rural physician in the SanLuisValley therefore does not get the benefit of consulting with the specialist in personand learning something handson. In the specialty areas therefore there is not much apprenticing" taking place for leaning sake in the Valley.

• In addition to a lack of access to CUM for physicians, the SanLuisValley, due to itssize and small population and isolation cannot provide many health educationprograms for the community. At this point in Alamosa there is no ongoing health education program aimed at the community.

(3)ANSWERS THROUGH TELECONFERENCING COMMUNICATIONS

First it is important to understand the basics of how teleconferencing works. Saint JosephHospital owns a dual monitor system and we would hope that we could purchase the same equipment for Alamosa. Let us say for example that Saint JosephHospital gives a presentation that involves slides to a group of 20 physicians in Alamosa. The physic' would see the presenter on one monitor and the slides on the other monitor. The Saint JosephHospital audience would probably see two different angles of the physicians in the Alamosa audience on their monitors. If Alamosa wanted to ask questions, they could do so at any time during the presentation and Saint JosephHospital would hear and see them ask these questions. If someone in the audience at Alamosa wanted to ask something of someone in the audience at Saint JosephHospital, the monitors on both ends of the connection could be trained to the audiences allowing them to see each other. The benefit of this interactive and flexible system is that it allows people to interact on a visual as wen as audio level in groups. It adds a new dimension, allowing people on both ends to learn from the remote audience as well as the speaker and local audience. It enables remote audiences to become involved in the dialogue instead of being only passive recipients.

There are several applications that this new teleconferencing equipment can be used for. Saint JosephHospital offers a wide variety of educational classes focused on physician continuing medical education credits as well as women's health classes directed at the community at large. We feel that both of these types of classes offered via interactive video would benefit any rural community in Colorado. As stated in our letter, we already have teleconferencing capabilities with our Grand Junction facility and have successfully begun using it for CME. We feel that our current interest and experience in teleconferencing can. provide some answers to some of the issues raised in the previous section:

• Saint JosephHospital currently offers Continuing Medical Education in topics such asInternal Medicine: Grand Rounds Stroke Management; Infectious Diseases: AIDS;Surgery for Ascending Aortic Aneurism; Assessment of Geriatric Patients; Orthopedic Conferences, etc. The Hospital tries to remain as uptodate as possiblewhen it comes to education so that we may help our patients in the most advanced andcompassionate manner.

With the new teleconference connection Saint JosephHospital will have the ability to

share all of these topics with Alamosa physicians on a weekly basis. Our CME

coordinator is also willing to create classes on special topics that Alamosa may want

to focus on or has a large number of cases in. Saint JosephHospital could help fulfill

Alamosa's need for specialty CME and tailor classes to their needs.

In order to bring the most uptodate medical knowledge to local Denver physicians,

the Saint Joseph Hospital Foundation also sponsors several lectureships during the

year. Nationallyrecognized leaders in their fields are invited to address members of

the medical staff. These lectureships are held for medical specialties such as surgery,