Department of Surgery Business Plan

Department of SurgeryBusiness Plan

FY 2007/2008

Surgery Mission

Our mission is to advance comprehensive healthcare by providing excellent surgical services, conducting innovative research, and ensuring exceptional education for all we serve.

Surgical excellence, innovative research, and exceptional education for all we serve

Integral Part of the

Community Health

Communication to

Stakeholders

Service Expansion Growth &

Recognition

Operation Improvement

Optimal Efficiency and

Resource Utilization

Enhanced Scholarly

Activity and Environment

VisionInternationally

Recognized as a Premier Academic

Department of Surgery in the

Midwest

Core Objectives

Department Summary 2 Endowed chairs 37,950 Patient encounters 3,497 Surgical procedures in CUMC OR 9 Divisions (12 sections) 35 Clinical Faculty Members 7 Research/Admin Faculty Members Residency Programs (preliminary, categorical,

orthopedics, emergency medicine, urology) Fellowship programs (Bariatric, Colorectal)

Department of Surgery 2007/2008

Program Development Opportunities

Cardiothoracic Surgery Continued development of the Endovascular

Program

Recruit surgeon with training in minimally invasive and robotic cardiac surgery

Support expansion of pulmonary service with development of lung reduction surgery

Support expansion and available surgical services for the oncology program with focus on solid tumors (joint program)

Develop clinical and research programs with cardiology and pulmonary medicine

General Surgery Develop a esophageal program and

comprehensive digestive disorders program

Expand new technologies in endoscopic devices (transluminal procedures) and technologies: mucosal resections, trans-oral anti-reflux surgery

Current recruitment of a surgeon who specializes in natural orifice trans-luminal endoscopic surgery (NOTES)

Develop new technologies and expand our experience with hernia repairs

– Focus on the heterogeneity of healing and the area of tissue engineering

General Surgery continued Trauma Service

– Build trauma team with emphasis on continuity of care.

– Achieve accreditation by State of Nebraska and American College of Surgeons.

– Continue to integrate the trauma service with the ICU to provide comprehensive continuity of care.

Bariatrics

– Expand the program and our area of expertise

– Market the Bariatric Center of Excellence designation

– Continue the development and integration of a comprehensive program with medicine and psychiatry

– Continue development of the weight loss program

Neurosurgery Expand the referral basis

– Expand outreach – Immanuel and Mercy Hospital

– Emphasis on tertiary surgery to CUMC

– Hire neurosurgeon to develop a comprehensive spine program

– Cyberknife program development

Explore functional neurosurgery

– Ablative resection and deep brain stimulation with neurologists

Expand the research on injured brain tissue and applications of brain tissue oxygenation

Develop a comprehensive neuro-oncology program

Orthopaedics

Recruit orthopedic spine, sports medicine, joint, and trauma surgeons

Continue expansion of the orthopedic oncology

Continue development of the joint replacement and sports medicine programs

Plastic Surgery

Plan for program development involving reconstruction (trauma, oncology, and urology)

Develop a program for cosmetic surgery

Recruit a second plastic surgeon

Continued development of the oral/maxiofacial program with the School of Dentistry

Surgical Oncology Emphasize solid tumor programs

– Disease specific programs (breast, melanoma, prostate, lung and bone metastasis, peritoneal carcinomatosis)

Collaborate with School of Medicine, hospital, and Dept. of Medicine and Radiology to build high profile Cancer Center (clinical, research and education)

Comprehensive Program for Peritoneal Carcinomatosis

– Develop a nationally recognized research program Utilize Federal programs to provide screenings for the

underserved Continue to increase volume in the Comprehensive

Breast Clinic in conjunction with radiology

Urology Recruit urologist with robotic expertise

Develop joint program for prostate cancer.

Develop program of pelvic reconstruction

– Area of clinical innovation (Healthcare Advisory Board)

Develop urology residency program in conjunction with UNMC

Vascular Surgery Recruit endo-vascular trained

surgeon

Re-establish vascular lab accreditation

Integrate a vascular practice with a business model that includes several surgeons (UNMA and VA).

Emphasize outcomes research and develop a research program linked to the national initiatives to improve surgical activities at CUMC

Transplant

Recruit Transplant Surgeon

Develop UNOS accredited kidney/pancreas transplant surgery program with nephrology

Successful recruitment and retention has led to program development opportunities

Several nationally known programs and surgeons within the Department

Joint program development with other Departments has led to increased volume

Increased outreach locations have enabled better payor mix, higher volumes

STRENGTHS

WEAKNESSES Divisions with only one provider

-difficult to establish a practice and cover trauma call

-at risk if surgeon becomes ill or leaves Difficulty establishing referral base for new surgeons Compensation plan

-leads to competition between faculty

-difficult for Department to absorb negative financial impact from low earning programs

Recent year end deficit from frozen adjustment rate reconciliation in combination with new lower overall adjustment rate has led to financial instability for individual surgeons and the Department

Summary Recruit

Develop new models for doing business

Build relationships, expand and secure sources of business

Provide highest quality patient service

Support education at all levels

Develop research programs

Establish new compensation plan

Department of Medicine Department of Medicine Clinical Strategic PlanClinical Strategic Plan

Joint Business Planning Joint Business Planning Session Session

August 29, 2007August 29, 2007

AgendaAgenda

Mission Mission

Leadership ChangesLeadership Changes

Strategic ReviewStrategic Review

MissionMission

Superlative clinical serviceSuperlative clinical service

Outstanding medical educationOutstanding medical education

Focused Translational Research Focused Translational Research

Associate ChairsAssociate Chairs

Dr. Robert DunlayDr. Robert Dunlay EducationEducation

Dr. Robert AndersonDr. Robert Anderson ResearchResearch

Dr. Aryan MoossDr. Aryan Mooss Academic AffairsAcademic Affairs

Dr. Laurel PreheimDr. Laurel Preheim VAVA

Dr. John HurleyDr. John Hurley Clinical AffairsClinical Affairs

New Division ChiefsNew Division Chiefs

Dr. Dennis EsterbrooksDr. Dennis Esterbrooks CardiologyCardiology

Dr. Syed Bin-Sagheer (Interim)Dr. Syed Bin-Sagheer (Interim) GIGI

Clinical PracticeClinical Practice

Clinical GoalsClinical Goals

Develop Cardiovascular InstituteDevelop Cardiovascular Institute

Expand Participation by Private Internal Expand Participation by Private Internal Medicine Practice Groups to increase Medicine Practice Groups to increase teaching opportunities and enhance clinical teaching opportunities and enhance clinical missionmission

Establish Hematology/Oncology Establish Hematology/Oncology Partnership to expand specialty services Partnership to expand specialty services

Clinical GoalsClinical Goals

Redesign and Expand Primary Care SitesRedesign and Expand Primary Care Sites

Improve Revenue Cycle ManagementImprove Revenue Cycle Management

Enhance Customer ServiceEnhance Customer Service

49,952,539

52,454,435

56,542,154

FY 04/05 FY 05/06 FY 06/07

DEPARTMENT OF MEDICINETOTAL CHARGES

24,070,537

25,761,057

27,791,549

FY 04/05 FY 05/06 FY 06/07

DEPARTMENT OF MEDICINENET PATIENT CARE REVENUE

EducationEducation

New Fellowship ProgramsNew Fellowship Programs

RecentRecent– Interventional Cardiology – 2006Interventional Cardiology – 2006– Endocrinology - 2006Endocrinology - 2006

PlannedPlanned– Gastroenterology - 2009Gastroenterology - 2009– Sleep medicine – 2010Sleep medicine – 2010– Nephrology Nephrology – Hematology/OncologyHematology/Oncology

Medical Education GoalsMedical Education Goals

Increase Clinical Volume for Student Increase Clinical Volume for Student Learning OpportunitiesLearning Opportunities

Enhance Department Support for Enhance Department Support for

Medical Education ProgramsMedical Education Programs

Improve Learner Evaluation ProcessImprove Learner Evaluation Process

Add newer simulation technologyAdd newer simulation technology

ResearchResearch

Research GoalsResearch Goals

Develop Genetics/Proteomics ResearchDevelop Genetics/Proteomics Research

(September 2007)(September 2007)

Improve Infrastructure and Admin SupportImprove Infrastructure and Admin Support

Strengthen Mentoring of New ResearchersStrengthen Mentoring of New Researchers

Increase Collaboration with Basic ScienceIncrease Collaboration with Basic Science

Recruit More InvestigatorsRecruit More Investigators

Establish Division of Clinical ResearchEstablish Division of Clinical Research

Department StrengthsDepartment Strengths

Clinical Clinical

- Cardiology- Cardiology

- GI Advanced Endoscopy- GI Advanced Endoscopy

- Internal Medicine- Internal Medicine

- Nephrology- Nephrology

- Pulmonary/Critical Care- Pulmonary/Critical Care

Department StrengthsDepartment Strengths

OutpatientOutpatient– Cardiology (metro and rural)Cardiology (metro and rural)– Rheumatology (metro and rural)Rheumatology (metro and rural)– Dermatology (metro and rural)Dermatology (metro and rural)– Nephrology (dialysis- metro and rural)Nephrology (dialysis- metro and rural)– Clinical Diabetes ExpertiseClinical Diabetes Expertise

Department StrengthsDepartment Strengths

ResearchResearch

- Allergy/Immuno-modulation- Allergy/Immuno-modulation

- Bone Health/Osteoporosis- Bone Health/Osteoporosis

- Community Health Center/Health - Community Health Center/Health DisparitiesDisparities

Current WeaknessesCurrent Weaknesses

Small Faculty SizeSmall Faculty SizeLack of Inpatient Teaching OpportunitiesLack of Inpatient Teaching OpportunitiesLimited Fellowship ProgramsLimited Fellowship ProgramsLack of Research Focus/Facilities Lack of Research Focus/Facilities Limited PhilanthropyLimited PhilanthropyLimited full-time GastroenterologyLimited full-time GastroenterologyLimited Hematology/OncologyLimited Hematology/OncologyAging Clinical FacilitiesAging Clinical Facilities

Opportunities forOpportunities forMedicine ServicesMedicine Services

Diabetes ProgramDiabetes Program

Specialty Hematology/Oncology Specialty Hematology/Oncology PartnershipPartnership

Nephrology/TransplantNephrology/Transplant

GastroenterologyGastroenterology

Women’s Health (Cardiac, Osteoporosis, Women’s Health (Cardiac, Osteoporosis, Preventive Services, etc)Preventive Services, etc)

Opportunities for DistinctionOpportunities for Distinction Omaha Market Omaha Market

Cardiovascular ServicesCardiovascular Services

Rural Satellite Cardiac ServicesRural Satellite Cardiac Services

Nutrition/Metabolism/Obesity CenterNutrition/Metabolism/Obesity Center

Osteoporosis - Women’s Heath Osteoporosis - Women’s Heath

GI - Advanced Endoscopy Procedure CenterGI - Advanced Endoscopy Procedure Center

Executive HealthExecutive Health

Opportunities Cont.Opportunities Cont.

Expand Community SitesExpand Community Sites– Explore New location in South OmahaExplore New location in South Omaha

– Consolidate Dundee GIM and Diabetes inConsolidate Dundee GIM and Diabetes in

Dundee Business DistrictDundee Business District

- Explore new site with CMA Explore new site with CMA

(Benson or Council Bluffs?)(Benson or Council Bluffs?)

ThreatsThreats

Competitor expansion in rural marketsCompetitor expansion in rural markets

Lack of CMA/CUMC Presence in Metro MarketLack of CMA/CUMC Presence in Metro Market

UNMC Research Growth/PhilanthropyUNMC Research Growth/Philanthropy

Financial Strength of Competitive Financial Strength of Competitive

Health SystemsHealth Systems

Faculty Recruitment Faculty Recruitment FY 2007FY 2007

ClinicalClinical

- Laura Armas, MD – Endocrine- Laura Armas, MD – Endocrine

- Robert (Trip) Wear, MD – Pulm/CC- Robert (Trip) Wear, MD – Pulm/CC

ResearchResearch- Langjuan Xiao, PhD – ORCLangjuan Xiao, PhD – ORC- Peng Xiao, PhD – ORCPeng Xiao, PhD – ORC- Gary Xiao, PhD - ORCGary Xiao, PhD - ORC

Faculty RecruitmentFaculty RecruitmentFY 2008FY 2008

Cardio-EP - Arash Aryana, MDCardio-EP - Arash Aryana, MDCardio Interventional - Michael White, MD Cardio Interventional - Michael White, MD Cardiology Imaging (2) Cardiology Imaging (2) Pulmonary/SleepPulmonary/SleepGI GeneralistGI GeneralistHematology Oncology Hematology Oncology Infectious Disease Infectious Disease Internal Medicine – CUMCInternal Medicine – CUMC

Capital RequirementsCapital Requirements

Primary Care Clinic Expansion/RemodelPrimary Care Clinic Expansion/Remodel

CUMC Clinic Expansion/RemodelCUMC Clinic Expansion/Remodel

Research Lab Consolidation/Remodel Research Lab Consolidation/Remodel

Infusion Center DevelopmentInfusion Center Development

New Program SupportNew Program Support

Nutrition/Obesity Start-upNutrition/Obesity Start-up

Hospitalist ProgramHospitalist Program

Rural Satellite DevelopmentRural Satellite Development

Community Awareness/MarketingCommunity Awareness/Marketing

2007/08 Planning -- Overall 2007/08 Planning -- Overall StrategyStrategy

Echo Laboratory Accreditation by Feb ’08Echo Laboratory Accreditation by Feb ’08

Life Flight PCI Rapid Response to CUMCLife Flight PCI Rapid Response to CUMC

Additional Telemetry Beds at CUMCAdditional Telemetry Beds at CUMC

Exceed Quality BenchmarksExceed Quality Benchmarks

Customer Service ExcellenceCustomer Service Excellence

Capital Expenditure Budget - $1.2MCapital Expenditure Budget - $1.2M– New EP LabNew EP Lab– New Echocardiography MachinesNew Echocardiography Machines

2007/08 Planning -- Overall 2007/08 Planning -- Overall StrategyStrategy

Cardiac CT Cardiac CT AngiographyAngiography

MRIMRI

3-D Echo3-D Echo

PETPET

Planning new clinical areas of expertise with Planning new clinical areas of expertise with faculty recruitment & in collaboration with other faculty recruitment & in collaboration with other disciplines/departmentsdisciplines/departments– Vascular expansion Vascular expansion

Diagnostic TestingDiagnostic Testing

Interventional ProceduresInterventional Procedures

– ImagingImaging

2007/08 Wellness Emphasis2007/08 Wellness Emphasis

Expansion of Corporate Worksite ProgramsExpansion of Corporate Worksite Programs– Tobacco Treatment Tobacco Treatment – Executive Physicals in conjunction with other Executive Physicals in conjunction with other

Medicine Divisions Medicine Divisions – Other Wellness-based Lectures/ProgramsOther Wellness-based Lectures/Programs

NutritionNutritionExerciseExercise

– Establish name recognition for CU/CUMCEstablish name recognition for CU/CUMC

Tobacco-free CU CampusTobacco-free CU Campus

2007/08 Risks to Plan 2007/08 Risks to Plan ImplementationImplementation

Lack of faculty recruitmentLack of faculty recruitment– Private practice $ enticementPrivate practice $ enticement– ↓↓ interest in academic medicineinterest in academic medicine

Encroachment on market shareEncroachment on market share– Heart hospital in West OmahaHeart hospital in West Omaha– Cardiac Transplant program at UNMCCardiac Transplant program at UNMC

CREIGHTON PSYCHIATRY2006-07 Highlights & Plans for 2007-2008

Business Plan

2007-2008

2006-07 Highlights

Collaborated with NHHS, Region 6, UNMC to develop Lasting Hope Recovery Center

Opened 2nd adult psychiatric inpatient unit (Dr. Qadri-IMC) Added to Child & Adolescent Clinic (Dr. Ogunleye) Increased size and scope of research Local, regional & national awards

– 33% of Faculty Listed as “Best Doctors”

Ended FY 06-07 with a positive bottom line ($89K)

2006-07 Performance

Patient care revenue >30% above projected revenue One new faculty exceeded revenue by 482% of projected!!

(Dr. Qadri) New NIH grant awarded (Dr. Happe). Psychiatry now has

4 NIH grants (Drs. Wilson 2, Happe 1, and Sullivan 1) Grants increased $1.6M ($1.5M $3.1M) … up 106%!

– Aside concerning research vis a vis hospital

Psychiatry generates new CU business …– Unique referrals: only 19% via CMA, 18% self referred, and 63% via other

agencies and physicians

A total of 3028 new charts opened ‘Case Finders’

Physician Recruitment

Faiz Qadri, MD, started July 2006. Exceptional work ethic Yetunde Ogunleye, MD, started in December 2006. Much

needed child-adolescent psychiatrist Currently recruiting faculty for the Lasting Hope Recovery

Center No physician has left the department in over 5 years

2007-08 Opportunities

New Office via University & School Capital Plan– Main site near CU (Radio Shack?) … with UNMC or alone

Boost faculty liaisons with OB, family medicine, internal medicine & pediatrics

Increase ‘mid-levels’ to reduce outside referral for counseling and therapy to providers outside the department … but new office space needed

Lasting Hope Recovery Center– Multi-disciplinary Statewide Initiative (Unicameral)

Threats

Limitations to expansion … Need to accommodate all faculty, staff and researchers at a reasonable rate

CMA issues (rent & pass-through levies a burden) Alegent Health wants to reduce support for Residency

Training and owes ~$500K Transition in Pediatric EDP at Childrens The gap between private practice and faculty salaries is

widening, to making it harder to recruit.

PSYCHIATRY & the HOSPITAL

Major presence via Consult-Liaison– Exceptional ROI

Opportunities to grow liaison services– Excellent clinical care & research opportunities

LHRC should ‘unpack’ ERs & other beds New office building offers ‘leverage’ Research = Visibility = Market Share Case-finders! Case-finders!! Case-finders!!!

Creighton University Family Medicine

Business Plan

FY 2007/2008

CUMC Family Medicine Admissions

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CUMC Admissions by Group

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CU FM

CUMC Admissions by GroupC

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2004 2005 2006 2007

Program Highlights

Positive Bottom Line FY 05/06 and 06/07 Charges increased by 3.5% Patient Visits decreased by 2%

– FTE remained the same replaced one of our most productive providers with a new recruit

– Dr. Baumberger – charges sufficient to eliminate need for start up support

Strengths

Strong, Stable, Experienced Faculty focused on system wide success

Fiscal Stability Strategic positioning of clinics

Weaknesses

Old Market Significantly Understaffed With Providers, and Awaiting Expansion; Patients Turned Away Daily

Lack of System Wide Strategic Plan for Investment in Primary Care

Further expansion impossible until investment issue resolved

Opportunities

Expansion of Old Market Clinic and Provision of OB Services

Development of R.O.I. model Development at Florence Clinic Continued Growth at Eagle Run

– Growth 3%

Threats

Retiring Primary Care Providers within the community and rural referral areas

Subsequent consolidation of community practitioners to existing health systems

Department high producers “burning out” Lack of rational investment model

2008 Planning

o Continue to grow practices to full capacity productiono Increase providers as space allows, and within the

limitations of maintaining a positive bottom line.o With Old Market build out, add one additional

provider July 2008. Ideally a female provider who does OB.

o Work cooperatively with Department of Surgery in the Bariatric Program.

o Work with Dean’s Office, CMA, CUMC to develop ROI investment model for system growth.

Business PlanFY 2007-2008

South Omaha presence Continue to support One World

Community Health Center Opened new “Twin Creek” office in Sarpy

County Staffed by new OB/Gyn generalists

Lisa Rice, MD Kathryn Kenna, MD

Faculty expansion in the following areas Maternal-Fetal Medicine Division Twin Creek Arbor ? Elsewhere in South Omaha

Balanced budget for fiscal year 2007-2008

Young, eager faculty willing to teach Resident education

Added one additional resident this year Student education

16-year average of 12% of each graduating class pursues a career in OB/Gyn, compared to a 6% national average

Strong clinical customer base

Research Small number of faculty

Coverage stretched thin

With Dr. Bonebrake’s departure, we have the opportunity to hire a female perinatologist

Masters program in biomedical science with emphasis on embryology Should facilitate research with basic

science More tuition dollars

Competition in South Omaha Possible loss of support from Bergan

for MFM Loss of faculty to private practice

Continue to hire excellent clinical faculty

Increase research activities Active in medical student and

resident education Nationally recognized in student

recruitment in OB/Gyn

Lack of adequate monetary support Plant facilities - lack of room for

expansion Lack of monetary support for fourth

resident Struggle for surgical equipment we need Battle for surgical times Lack of dedicated Spanish interpreter

Needed 24/7

No pediatric anesthesiologists at CUMC Must deliver babies with anomalies at

Methodist Great loss of revenue as a result

Have one additional resident approved by the Residency Review Committee for each of the next three years for a maximum of 16, but we have no monetary support, so we can’t fill those spots

Keep up with state of the art ultrasound equipment

Resident salaries Monetary support for new faculty

hires Rebuild our plant fund

Creighton University Neurology

Business Plan

FY 2007/2008

06-07 Program Highlights

International Recognition in Parkinson’s Disease Research – Done at CUMC

APDA Coordinator – Located at CUMC

- Covers NE, KS, SD (Lisa Brovold)

- Nebraska PD Registry

Headache/Pain Clinic Multiple Sclerosis Support Center

07-08 Development Opportunities

Recruitment Multiple Sclerosis Support Center Dementia/Alzheimer Support Center Neuro Intensivists/Stroke Care Vision is for Neuroscience Center

– Coordinated Comprehensive Care

Market Factors: SWOT Analysis

Strengths:– Reputation/Respect in PD (APDA Office & Research Activities)– MS Patient Base Maintained– Dedicated Staff

Weaknesses:– Faculty Shortage– Shortage/Inadequate Space– Clinic Renovation

Opportunities: More Market Share for Demographics– Community Support– Multiple Sclerosis/Alzheimer Support– Vascular/Stroke– Neuromuscular– Epilepsy

Threats:– UNMC (Loss of Market Share)– Private Practice– Perception

Physician Recruitment/Retention

Goal: Recruit Faculty with Critical Skills:– EMG, EEG– MS Specialist – No MS Specialist in Nebraska– Dementia/Alzheimer Specialist– Intensivist

Obstacles:– Salary– Lack of Program Support– Insufficient/Poor Appearance

Capital Needs

Three Year Projections:– Additional Space for Faculty/Staff/Patients– Renovation of Current Space

Creighton University Department of Pathology

Business plan

2006/2007

2006/2007 CUMC laboratory Performance Highlights

• New blood bank Director started January 2007 (Lisa Tyler, M.D.)• Implementation of two chemistry analyzer instruments (Roche

Integra 800s)• Implementation of ionized calcium instrumentation• Implementation of osmometer instrumentation• New tissue cassette labeler• New gel technology implemented in blood bank• New bariatric morgue cart• New Stryker saw• Six new phlebotomy carts• Successful CAP inspection for both CUMC and CML laboratories• Successful AABB inspection for CUMC blood bank laboratory

2006/2007 CUMC laboratory Performance Highlights

Clinical Labs Volume Trend

602189659645

815485863453 867013 855531

200000

300000

400000

500000

600000

700000

800000

900000

1000000

2001 2002 2003 2004 2005 2006

Billable units

Anatomic Labs Volume Trend

46985 48136

62653

7204365735

60667

20000

30000

40000

50000

60000

70000

80000

2001 2002 2003 2004 2005 2006

Billable units

2006/2007 CML Performance Highlights

• Successful opening of new Anatomic Pathology (AP) laboratory including implementation of new laboratory information system (LIS) – February 2007

• Began drug testing for Creighton Schools of Nursing, Pharmacy, Medicine, Dentistry and Physical Therapy

• Creighton Medical Laboratories (CML) acquired 20 new clients

2007/2008 CUMC laboratory Program Development

Opportunities• Replacement of hematology equipment

(Sysmex)• Replacement of Access II immunochemistry

instrumentation• Replacement of tissue processors and

microtomes• Purchase of additional storage refrigerator and

freezer banks• Replacement of Vitek 2 Micro ID• Cerner LIS upgrade

Physician Recruitment

• Currently have filled all open faculty positions• New faculty members

– Caishu Deng, M.D. – start date July 1st

(Cytopathology, FNA)

– Hina Naushad, M.D. – start date July 1st

(Hematopathology, Surgical Pathology)

– Susan Repertinger, M.D. – start date July 1st

(VAMC)

– Lisa Tyler, M.D. – start date January 1st

(Blood Bank)– Qingmei Xie, M.D. – start date July 1st

(Hematopathology, Flow Cytometry)

Pediatrics Program Development

2007-2008

MISSION

TO PROVIDE Quality HEALTH CARE TO ALL CHILDREN OF THE OMAHA METROPOLITAN AREA AND THE REGION

TO DO SO WITHOUT REGARD TO RACE, RELIGION OR ABILITY TO PAY

Program Highlights

To expand specialty Pediatrics in Sarpy County, West Omaha, Council Bluffs and at CUMC.Especially in the area’s of:

Gastroenterology Rheumatology

Endocrinology Developmental Pediatrics and

Intensivist (critical care) services Hospitalist Services

Performance

In the last three years there has been general growth of between 3-4% annually in the areas of general pediatrics , Gastroenterology, Pediatric Cardiology and Neonatal intensive care and Allergy services .We had over 20,294 pt visits in 06 at the CU clinic and we are currently averaging approximately 3% over our 2006 numbers. New Intensivist services generated approximately 23% more revenue than originally forcast for the year in only an (8) month period.

Market Description

Current market includes Eastern and greater Nebraska as well as Western Iowa and parts of South Dakota

Competition

Potential competitors

UNMC/ Children’s

Currently also key partners

Strengths and Weaknesses

Strengths:

Current reputation and primary care physician referral network.

Rheumatology only provider in region

Alegent, Boys town partnership with GI

Tenet support Intensivist services

The Neonatology group currently manages three out of four of the level three NICU units in the community.

Strengths continuedThe CU Childhood obesity program has won both state and national recognition for its work with inner city children and family’s.

Weakness

Number of faculty needed to provide and or grow services

Competition with Children's and UNMC

Need for capitalized funding to grow services

Hospital Collaboration

Support for Intensivist services, in order to grow inpatient pediatric programs: PICU and General Peds.

Support to create regional Pediatric Childhood obesity center

Space and facilities in order to enhance Specialty care clinics at CUMC

Support for Pediatric Hospitalist Services

Hospital Collaboration

Help develop a food hypersensitivity feeding and swallowing program for children in the region.

Summary

Our primary mission is to enhance and provide quality education and experiences for our Students and Residents while providing quality care for our patients and their families.

The department must collaborate and work with multiple partners in order to achieve its goals

The department also wishes to PLAN and DEVELOP a MAJOR REFERRAL AND RESEARCH CENTER IN the area of NUTRITION AND Child Abuse OVER the NEXT FIVE YEARS

Department of Anesthesiology

Creighton UniversityDepartment of Anesthesiology

Business PlanFY 2007/2008

Department of Anesthesiology

FY 06/07 Performance Highlights

Recruitment of 1 M.D., 1 CRNA

Increased Research funding/efforts

Implemented TeamSTEPPS

Department of Anesthesiology

SWOT Analysis

Strengths: Very experienced staff, well trained, work long hours

Weaknesses: lack of own Residency program, chronic under-funding, CUMC clinical revenue alone cannot support Dept.

Opportunities: able to attract more interest from CRNAs

Threats: financial instability, uncertainty

Department of Anesthesiology

Recruitment

FY 07/08 Goal: New Chairman, 1 staff Anesthesiologist, 1 CRNA

Obstacles: current salary & benefits for Physicians not competitive

Department of Anesthesiology

Capital Needs

Electronic Anesthesia Record: two vendorsgave demo in 2007; approx. cost to implementis about $400K

Glide Scope for emergency airway management

Department of Radiology

Accomplishments ‘06-‘07

Department of Radiology Accomplishments ‘06-‘07

Clinical

1. Brought to and sustained a 90% turnaround time of x-ray reports within 24 hours of the completion of the exam.

2. Collaborated with CUMC in capital equipment purchases. During this academic year, installation was completed on:

a. 64 Multi-Detector CT

b. Angio Suite

Department of Radiology Accomplishments ‘06-‘07

3. Successfully recruited two new faculty members

a. Attila Csordas, M.D.- Chief of Vascular and Interventional Radiology

b. Olaf Kaufman, M.D., Ph.D.Radiology Director for Cardiac CTA Acting Chief of Neuroradiology

4.Sustained and grew the angiography program by recruitment of the Methodist Radiology Group to provide half time coverage in vascular and interventional radiology. The other 50% time was covered by the Chairman of the Department of Radiology.

Department of Radiology Accomplishments ‘06-‘07

Department of Radiology Accomplishments ‘06-‘07

5. Stabilized and improved morale in the department despite the departures of three radiologists at about the same time. This was accomplished by ongoing meetings of the chairman with individual attendings, as well as with the attendings as a group and with chief radiology residents individually and with the radiology residents as a group.

Department of Radiology Accomplishments ‘06-‘07

6. Continued success of the Center for Breast Care despite personal challenges for Dr. Mary Davey. In her absence care was provided by our other radiologists credentialed in mammography.

7. Was an advocate for the Werner Institute to be involved in developing a “win-win” relationship in areas that have resulted in major turf battles and institutional disruption throughout the country.

Department of Radiology Accomplishments ‘06-‘07

8. The Radiology Department at CUMC was chosen as the imaging center for the Creighton University athletic program. This was accomplished by concerted effort of the Radiology Department, CUMC Administration and CMA faculty.

9. Developed as part of a multidisciplinary QA team, a grid that lists urgent and emergency procedures. This improved referring clinicians ability to obtain such examinations on weekends and evenings.

Department of Radiology Accomplishments ‘06-‘07

10. Department funded training of four radiologists to be credentialed in cardiac CTA.

11. Initiated a RAD Peer ACR QA program.

12. In radiation oncology, treatment modalities of IMRT and HDR therapy were successfully initiated. This has improved patient care.

13. Balanced the budget.

Department of Radiology Accomplishments ‘06-‘07

Residents1. Written boards in diagnostic radiology;

ranked 5th of 203 programs in North America.

2. Oral boards: all three graduating residents passed on their first attempt.

Faculty1. Jim Phalen – Golden Apple

Program Development Opportunities

for 7/07 – 6/08

Program Development Opportunities for 7/07 – 6/08

A. Develop and participate in multidisciplinary teams for improved patient care, research and revenue.

1. Develop Cardiac CTA program with Cardiology Division whereby Creighton University Medical Center is the provider of choice for patients – facilitated by Werner Institute

Program Development Opportunities for 7/07 – 6/08

2. Contribute to cancer program growtha. Cyberknife project

i. Radiation Oncology

ii. PET/CT

b. Vascular and Interventional Radiologyi. transcatheter embolization

ii. image guided ablative therapy

a. radiofrequency

b. cryoablation

iii. placement of ports for chemotherapy delivery

Program Development Opportunities for 7/07 – 6/08

3. Participate in discussions with Departments of Medicine and Surgery on forming a Cardiovascular Institute - facilitated by Werner Institute

4. Expand Creighton University athletic sports medicine program in collaboration with Orthopedic Division

Program Development Opportunities for 7/07 – 6/08

B. Increase revenues1. PAC Office scheduling of elective exams

within 24 hours

2. Marketa. Vascular and Interventional Radiology

b. Cardiac CTA

c. Interventional sports medicine program

3. Discussions on out-patient imaging center

Program Development Opportunities for 7/07 – 6/08

C. Maximize customer satisfaction1. QA program

a. Turnaround time

b. RAD Peer

c. Pursue enrollment in national calling center (Veriphy) for critical values

d. Monitor PAC office scheduling of out patient procedures

Market Factor - SWOT AnalysisStrengths

1. Faculty2. Desire to increase revenues

Weaknesses1. Absence of an outpatient imaging facility2. PAC Office3. Dual Registration4. CUMC marketing is planned 1 year in

advance – may not take advantage of arrival of new faculty

Market Factor - SWOT Analysis

Opportunity1. Develop an outpatient imaging facility2. Complement existing faculty with new faculty3. New multidisciplinary programs

a. Cardiacb. Uterine fibroid embolizationc. Cancer cared. Interventional neuroradiologye. Sports medicine

Threats:1. CUMC Market Share of 11%

Physician Recruitment/Retention

Goals:1. Retain existing faculty

2. Recruit1. Chief of Neuro Radiology

2. General Diagnostic Radiologist

Obstacles: 1. Salary differential

2. 500 vacancies in 100 academic radiology departments

Capital Needs(3 Year Projections)

Nuclear Medicine Camera

MR Cardiac Package 3T MRI Digital Mammography Prone Stereotactic

Breast Biopsy Table Biplane Angiography

Suite

PACS Upgrade Radiology Information

System Upgrade Voice Recognition

Dictation Upgrade Digital Trauma Room Digital Radiography

Room