2009 Strategic Plan Update

TELLURIDE MEDICAL CENTER

• Operates two healthcare business units

1. Trauma & Emergency Services is a full service Level V Trauma Center that provides emergency care on a 24/7 basis
2. Primary Care is a multi-specialty medical practice with two full-time doctors and a number of visiting specialists

• Has two affiliated organizations

1. TMC Foundation – charitable fundraising organization
2. IFAM – altitude medicine charitable research organization

• Provides medical services to a relatively small mountain resort community remotely located at an altitude of 8750 feet and 65 miles from the nearest hospital

• Experiences seasonal fluctuations in patient volumes that are driven by ski season and summer visitors, with a peak demand during the winter months and a smaller spike during the summer

• Receives tax support used to subsidize 24/7 emergency care and provide medical safety net for the community

STRATEGY OVERVIEW

For the past several years, TMC strategy has been focused on:

• Providing high quality medical services
• Operating efficiently and profitably
• Expanding medical services available locally
• Developing plans for a new facility

2008/2009 economic recession has delayed the new facility

• Local voters rejected all bonds/tax increases including bond for new medical facility and Telluride voters rejected building a medical center on the RV lot
• Need for expanded emergency room still critical
• Projected growth slowed and delayed
• Funding new facility with grants and charitable giving more difficult

2009 Strategic Priorities

• Continue to provide high quality medical services.
• Continue to operate efficiently and profitably despite downturn in business volume.
• Review role/mission of TMC in response to issues and concerns raised during past year.
• Develop plans to expand and upgrade emergency room facilities in the near term.
• Conduct review of health care affordability and medical “Safety Net.”
• Revise plans for new facility in response to November voting results and current economic environment.

2009 KEY STRATEGIC ISSUES

1. What is TMC’s role in the community and what should tax dollars be used to support?

2. What should be the plans for a new  or improved facility?

STRATEGIC ISSUE #1:

ROLE OF TMC

Issues and concerns regarding TMC’s role

• Given that TMC receives tax support for 24/7 emergency care, should TMC provide any additional medical services?
  
• Should tax money be used to subsidize additional medical services beyond emergency care such as primary care and visiting specialists?
  
• What is TMC’s role vis-a-vis the private sector?
  
• Should TMC provide medical care to all patients, regardless of their ability to pay?
  

History

• TMC was established over 30 years ago to meet community needs for both primary care and emergency care beyond those provided by a part time surgeon.

• THD has been a tax district for 25 years and voters have regularly approved  supporting TMC’s operations through taxes.  While the 2002 mill levy increase specified the purpose was to support 24/7 emergency care, the 1994 mill levy increase did not specify a purpose and the1999 mill levy increase was to support operating and maintenance expenses for TMC.

TMC’S Role in the Community

Emergency Care

• TMC has been providing emergency care since its inception
• Much of the tax support that TMC receives was specifically approved by voters to support a 24/7 emergency care facility
• Emergency care is the core of TMC’s role
  
  

Primary Care

• TMC was originally established as a community clinic and emergency center.  TMC helped to meet a great community need for locally available primary care and family oriented healthcare
• TMC has been providing primary care in Telluride for over 30 years
• Having both primary care and emergency care in the same facility provides operating efficiencies and some surge capacity for emergency care
• While some of TMC’s tax support was approved for general operating expenses which would include primary care, TMC’s primary care business currently has a positive financial impact on TMC.  The only tax monies that are used in primary care cover safety net or uninsured care expenses.  Many of these services can be provided at a lower cost in the community clinic rather than in the emergency room
• Serving as a source of locally available primary care is a key part of TMC’s role

Private Sector

• TMC has served for years as a facilitator for expanded medical services for the community.  Many specialized medical services have been provided by private medical practices working in conjunction with TMC
• Many of these specialized medical services would not be available locally without support from a facility like TMC.
• The only private primary care doctor in town got started by originally working at TMC.  His practice is currently enhanced by being able to refer patients to TMC for specific medical procedures that his patients would otherwise have to travel to Montrose to obtain
• TMC’s role is to encourage and support locally available private sector medical practices.  Tax monies are not specifically used for this purpose

Safety Net

• TMC is the only non profit medical facility in the local area and the only medical facility to receive tax support.
  
• TMC is currently the only Medical Safety Net for the community
• TMC must provide medical care to all patients, regardless of their ability to pay
• Tax support is used to cover uninsured care

Summary of TMC’s Role in the Community

TMC is dedicated to providing and supporting locally available, high quality medical and healthcare services for residents and visitors in the Telluride region.

 
This is accomplished by:

• Operating a Level V Trauma Center that provides emergency care on a 24/7 basis
• Operating a family care practice to ensure that general and family practice care are available locally
• Operating a community clinic to provide access to high quality healthcare services for those in need, regardless of ability to pay
• Encouraging and supporting an increased range of healthcare services offered locally by a number of private medical practices

STRATEGIC ISSUE #2:

NEW OR IMPROVED FACILITY

Issues

• How large of a facility does TMC really need? 
• What medical services should be provided in a new or improved facility?
• Where can TMC find a site for a new facility?
• Are there opportunities with existing site?
• How does TMC fund a site purchase and the costs of building a new facility?

Need

• Existing facility operates at capacity during peak season and has limited space to increase the volume and scope of healthcare services offered
  
• Emergency room fills up and operates in overflow mode about half the time during peak periods
• Design of existing facility is not compatible with good medical practices

1. Facility lacks area to receive emergency patients properly and has limited space for emergency patients
2. Facility has limited patient privacy at reception desk, at patient billing, and for emergency patients and families
3. Design does not meet current health facility safety standards

• Poor facility is root cause of majority of negative patient feedback regarding their experience at TMC
• TMC badly needs a new or improved facility.

Options for facility expansion

1. Remodel existing facility

• Remodel would be extensive
• Land and existing building are owned by Idarado
• Existing site has a number of limitations:
• Room to expand
• Emergency vehicle access
• Parking
• Difficult to remodel without adversely impacting current operations

2. Build a new facility on the same site

• Same site related issues as remodeling
• Major concern would be where and how to provide healthcare during the two year construction period

3. Build on a new site, either new structure or remodel existing structure

• Preferred option
• Most pragmatic approach from an operating perspective.  TMC would continue operations in existing facility and move to new facility when completed
• Biggest issue is location

2008 Plan

• Build a new facility on the RV lot at the entrance to Telluride
• Fund 50% of the cost with bonds.  Provide the rest from charitable contributions and other sources
• Plan was developed during spring and summer of 2008, before the economic crisis

Outcome

• District voters rejected the bond along with all others during November 2008 elections.
• Telluride voters denied allowing a medical center to be built on the segment of the RV lot that belongs to the Pearl property.
• Economic crisis has made raising money through charitable contributions considerably more difficult.
• TMC currently has neither funds nor site for building a new facility.

Current Plans

• A new facility is at least 5 years away.  (Acquiring site, planning, funding, construction).
• Improvements to the emergency room must be made sooner.  Only short-term option is to remodel existing facility.  This should be done at minimum cost as TMC does not own the land or building and the site is not large enough to support future needs.
• Consultant will revise new facility business plan using updated growth projections and other changes that could reduce costs.
• THD will have workshop to discuss facility size and update site matrix.
• Next step in planning for a new or improved facility is finding a site.
• TMC should minimize expenses until economic climate improves.

2009 Strategic Priorities and Action Plans

1. Continue to provide high quality medical services

2. Continue to operate efficiently and profitably despite downturn in business volume

3. Review role/mission of TMC in response to issues and concerns raised during past year

4. Develop plans to expand and upgrade emergency room facilities in the near term

5. Conduct review of health care affordability and medical “Safety Net”

6. Revise plans for new facility

1.  Provide high quality medical services

1. Increase telemedicine
2. Implement IT strategic plan
3. Increase benefits of relationship with St. Marys
4. Increase benefits of relationship with IFAM
5. Conduct medical staff reviews of strengths and weaknesses of TMC capabilities and operations after completion of each peak season
6. Consider a community survey of the total patient experience with TMC

2.  Operate Efficiently and Profitably

1. Budget for anticipated lower service volumes
2. Conduct regular and timely financial reviews of operating performance, taking corrective action as necessary
3. Examine efficiency, cost effectiveness and impact on patient experience of all administrative services
4. Identify additional opportunities for cost reduction

3.  Review role of TMC in community

1. Conduct workshops to review and examine:
1. Unique public/private characteristics of TMC
2. Purpose and utilization of tax subsidy
3. Impact on “core services” of additional medical services offered at TMC
4. Perspectives of TMC stakeholders – Patients, taxpayers, residents, staff, ski area, tourist businesses, construction businesses
5. What TMC’s role should be regarding expanding medical services available locally and improving community wellness
2. Take actions to demonstrate and communicate the value of TMC to the community

4.  Expand and upgrade emergency room.

1. Develop plans to expand and upgrade emergency room within the existing facility to bridge the gap until a new facility is available
2. Goal is to increase capacity and to improve quality of care and overall patient experience
3. Costs need to be minimized due lack of funding and limited planned life for expansion/upgrade
4. Identify ways to increase peak capacity utilizing existing personnel and revised facilities
   

5.  Healthcare affordability and Safety Net

1. Meet with Safety Net experts to identify best practices
2. Identify ways to lower the costs of providing healthcare for the community
3. Consider ways to revise service delivery to patients that could provide lower costs for the patient.  (Service delivery includes both medical and administrative services)
   

6.  Revise plans for new facility

1. Conduct workshops to review and revise new facility business plan
1. Growth projections
2. Plans for medical services and space requirements
3. Funding options
2. Explore site options
3. Work with newly established fundraising organization to help increase their effectiveness
4. Continue to communicate need for new facility