This protected Word document can be used to send information to us and to choose what analyses you want performed. The form creates a draft Professional Services Agreement and Scope of Services. When a default value is displayed, the default is the most common selection. After you have filled in the Word document, please e-mail the Word file to Franklin-Dexter@UIowa.edu.

When Dr. Dexter reviews your draft, he will use Track Changes so that all edits can be seen quickly. If after sending your e-mail you do not receive a Reply within one workday, please call Dr. Dexter at +1 (319) 621-6360.

If you have more than one independently staffed facility for the service-specific staffing statistical analysis, PACU analysis, financial analysis, etc., and if all contact information for the facilities is identical, fill in one document and in your e-mail explain how many analyses to plan. If contact information for support will be different, as is usually true, complete separate documents. If the facilities are sufficiently close geographically for one common on-site visit, only include the visit in one of the documents. Dr. Dexter will combine the Scope of Services together into one file with one Professional Services Agreement.

Navigate between items by using the tab key. Click in each box with your mouse (e.g., to select Yes or No to Scope of Services). As you fill in the form, the boxes expand to accommodate your text.

Use your vertical scroll bar to move up and down in the file and to read the paragraphs. Use View Print Layout to see formatting. Duplicate information will be inserted automatically. Therefore, complete the form sequentially (i.e., start at the beginning).

What date would you like the work started? Today’s date is May 8, 2023.     

What is the name of your organization for use in the reports?Limit to 50 characters and do not use any symbols (e.g., / , ? < : * > \ ” | ^)

     

Does your organization have a master agreement with the University for the services?

No, Proceeding to next page

Contact Information for Professional Services Agreement

What is the name of your organization for the Professional Services Agreement?     

What is the address to appear in the Professional Services Agreement?Street       (separate lines with commas)

City      

State or Province       (written out in full)

Postal code      

Who will be signing the agreement and what is his or her title?

Name      

Title      

Page 1THE UNIVERSITY OF IOWA DEPARTMENT OF ANESTHESIA

PROFESSIONAL SERVICES AGREEMENT

This Agreement is entered into as of       by and between the University of Iowa (hereinafter known as “University”) and      ,      ,      ,      ,       (hereinafter known as “Recipient”), wherein University agrees to provide management consulting services (hereinafter “Services”) as provided upon the following terms.

1. Professional Services: University agrees that the Department of Anesthesia will provide Services as described in the attached Scope of Work. The Parties agree that in the event of a conflict of terms between this Agreement and any other written documentation, including, but not limited to language contained in a Purchase Order, the terms and conditions of this Agreement shall control.

2. Performance Period: This performance period of this Agreement shall begin on       and continue until Services are completed as specified in the Scope of Work.

3. Compensation and Payment

A. Recipient agrees to pay the University for Services provided pursuant to this Agreement in accordance with the attached Scope of Work. Such payment shall include any and all applicable travel expenses including, but not limited to, air travel, ground transportation, lodging, and meals.

B. Recipient shall receive an invoice outlining all charges, submit all payments within 30 days following completion of Services, and send payment to:

Franklin Dexter Tel. +1 (319) 621-6360Department of Anesthesia, 6-JCP Franklin-Dexter@UIowa.eduRoy J. and Lucille A. Carver College of Medicine University Taxpayer ID: 42-6004813Iowa City, Iowa 52242-1009

4. Intellectual Property Rights: The Parties agree that any intellectual property used in or created by the provision of Services shall remain the sole property of the University. The Parties agree that the intellectual property rights to CalculatOR and other software developed by Medical Data Applications, Ltd., as utilized for the provision of Services, is and shall remain the sole property of MDA Ltd.

5. Termination: Either Party may terminate this Agreement by providing thirty days prior written notice. Upon termination for any reason, Recipient agrees to pay the University all fees and expenses already incurred through the effective date of termination. The University agrees to provide to Recipient any analysis completed as of the effective date of termination.

6. Confidentiality of Information: The Parties agree to keep confidential and not to disclose to third parties any information provided by either Party pursuant to this Agreement that are labeled as “Confidential” unless such disclosure is required by law. This provision shall survive expiration and termination of this Agreement. The Parties expressly acknowledge and agree that the University, as a state entity, is subject to Public Records Law, Iowa Code Chapter 22.

7. Liability

A University: The University agrees to be responsible for any claims, damages, losses, costs and expenses, including attorney fees, arising out of or resulting from the negligent acts or omissions of the University, its employees or agents to the extent permitted by Chapter 669 Iowa Code.

B Recipient: To the fullest extent allowed by law, Recipient agrees to indemnify and hold harmless the University of Iowa, State of Iowa, and Board of Regents, State of Iowa and their agents and employees from and against all claims damages, losses, costs and expenses, including attorney fees, arising out of or resulting from the activities of Recipient, its partners, directors, officers, employees, licensees, subcontractors or agents under this Agreement.

8. Modification: This Agreement constitutes the entire understanding between the Parties with respect to the subject matter hereof and may not be amended except by an agreement signed by the Recipient and an authorized representative of the University.

9. Governing Law: This Agreement shall be governed by and construed under the laws of the State of Iowa, which shall also be the forum for any disputes arising hereunder.

IN WITNESS WHEREOF, the Parties hereto have respectively signed this Agreement as of the latest date inscribed below.

University of Iowa Recipient

Page 2

___________________________ ______________________________________David W. Kieft      University Business Manager      

_____________________ (date) _____________________ (date)

The charges listed in the Scope of Services are the same for all organizations; they are not reduced without a concomitant decrease in expected effort.

Dr. Dexter has no incentive program and should not be listed in an Open Payments (Sunshine Act) disclosure. Corresponding financial disclosure is at www.FranklinDexter.net/FAQ/FAQ_a1.pdf

If the preceding Professional Services Agreement were not acceptable as written, an administrative fee of $500 will be added to the Scope of Services and the minimum total charge for the agreement will be $2000. Several University departments review each modified agreement, which can take two weeks. In our experience, modified agreements are approved when the following apply:

Items 3A, 4, 5, 7A, and 7B are present with the same language, with the exception of switching the names of the parties. If your counsel has questions regarding the liability sections 7A and 7B, relevant Iowa Code is described at http://www.legis.iowa.gov/law/iowaCode/sections?codeChapter=669&year=2014

The governing law (item 9) is either that of the State of Iowa or not listed.

Nondisclosure agreements exclude judicial action, Government regulations, or law. As a State entity, the University is subject to State of Iowa Open Records Law. The University must disclose information if it is requested, regardless of any contract entered into with language to the contrary, unless there is an expressed provision to keep information proprietary. For example, the agreement itself is subject to Open Records Law.

Exclusivity is not required. Exclusivity would be inconsistent with the educational (academic) mission of the University. In addition, for many consultations, Dr. Dexter does not know the facility or company for whom data are being analyzed. For more information, you can view www.FranklinDexter.net/FAQ/FAQ_a0.pdf

Business Associate Agreements are not included for the Scope of Services listed below, because there is no reasonable circumstance when personally identifiable health information would be transferred as part of any of the analyses.

A section on insurance would include language similar to the following:

University shall, as a state entity and through a program of self-insurance, maintain and keep in full force and effect throughout the time of performance under this Agreement, general liability insurance and professional liability insurance with limits of not less than One Million Dollars ($1,000,000.00) each occurrence and Three Million Dollars ($3,000,000.00) in the aggregate. Prior to commencement of services under this Agreement, the University shall obtain and attach hereto as Exhibit A Certificates of Insurance, which shall clearly evidence all insurance required in this Section.

Will the Professional Services Agreement on the preceding page be used?

Yes, University agreement will be used.

Contact Information for Services

Who will be the primary contact person for the services specified below?Manage project internally including setting deadlines based on his or her knowledge of the science

Name      Degrees       (e.g., MD MBA)Title       (e.g., Anesthesiologist)E-mail address      

E-mail will be sent to the primary contact, who may forward it to many others. What e-mail salutation is preferred (e.g., “Frank” or “Dr. Dexter”)?

     

Who else should be Cc on e-mail, sent copies of reports upon request, and be able to initiate extra work (e.g., by sending e-mail asking questions)?(All can and often are left blank, but if fill in copy and paste e-mail addresses to be precisely correct)

Name      E-mail address      

Name      E-mail address      

Name      E-mail address      

Name      E-mail address      

Name      E-mail address      

Name      E-mail address      

Name      E-mail address      

Name      E-mail address      

Name      E-mail address      

Page 2

Scope of Services

Service-specific operating room staffing and operational assessmentE-mail is used to learn about the characteristics of the OR information system data, anesthesia information management system data, or anesthesia billing data. Based on responses, an Excel file is customized into which the data are imported. The following analyses are performed:

1. OR staffing (i.e., allocations) that maximize OR efficiency, for each surgical service [specialty, group, and/or surgeon]. OR efficiency considers not just under-utilized OR time (i.e., utilization), but also the higher cost of planning too little OR time resulting in staff having to work late

2. Analysis includes calculation of each service’s OR workload3. Analysis includes estimation of the reduction in cost and increase in productivity that your

facility can achieve from service-specific OR staffing based on maximizing OR efficiency4. Analysis includes comparison of turnover times to benchmark facilities and among services,

assessment of variation in prolonged turnover times by time of the day, and estimation of the impact of reducing turnover times and delays on staffing costs and surgeon waiting

5. Analysis includes a comparison of cancellation rates by service, as cancellations on or just before the day of surgery influence staffing

6. Analysis includes assessment of bias in scheduled case durations, as it influences staffing7. Analysis includes Bayesian methods for case duration prediction (e.g., to reduce over-

utilized OR time by filling holes in OR schedule and reducing equipment conflicts)8. OR staffing for late afternoons and evenings to minimize staffing costs (e.g., ten ORs to 3 PM,

seven ORs to 5 PM, two ORs to 7 PM, and one OR after that)9. Analysis includes a comparison of this staffing solution to that obtained using the traditional,

albeit inaccurate, approach of staffing for the mean number of cases at each time of day10. Analysis includes reports providing late working anesthesia providers realistic end times11. OR staffing for weekends and holidays to minimize staffing costs, while managing your risk

of being unable to provide prompt patient care12. Analysis includes an assessment of the combination of staff on-call from home versus

on-call in-house in order to minimize staffing costs13. Surgeon waiting from scheduled start times, both first cases of the day and later in the day14. Optimal patient ready times on day of surgery to prevent delays and unnecessary waiting15. Surgeon number of eight-hour blocks per 2 weeks that match the service-specific staffing 16. Long-term estimated workload and capacity requirements

A report is e-mailed as a PDF file. A written summary of the interpretation of each page of the report is included in the e-mail (click here for explanation). Alternatively, the report is summarized during a web conference lasting approximately 1.5 hours. The University charges $4250 for these analyses.

When anesthesia information system or billing data are used, specialty is used as the service (e.g., in analyses 1-2). When calculations are being done for purposes of an anesthesia agreement, the dollar value from analysis 3 is reported per $100,000, for use with national survey data (e.g., MGMA).

The budget is based on an analysis for one common set of staff. If there are separate sites, OR allocations can be performed by considering the sites to be separately named services. For example, the non-OR locations such as Interventional Radiology can be referred to as the “non-OR” service. Allocation of first-come first-served, open, unblocked, OTHER OR time will be considered shared. Assessments of turnover times, costs, afternoon staffing, and weekend staffing will be pooled among sites. If the data are pooled among multiple facilities (e.g., an anesthesia 1st shift staffing

Page 3

analysis [#1 and #2]), then Dr. Dexter will work with the organization’s analyst sending the data to prepare the data such that each service specifies a facility. Dr. Dexter will also evaluate each analysis and its results to exclude those that are uninterpretable. Budget this additional work as taking 3-hours (i.e., $750).

Repeating analyses, creating customized reports, and/or having additional meetings would be billed at a rate of $250 per hour of Dr. Dexter’s time, charged to the nearest minute. Budget a fixed 2-hours ($500) for Dr. Dexter to provide an Excel worksheet to apply the Bayesian method for case duration at the OR control desk or from within a web page. There will be a $250 charge(s) for a wait of more than 4 weeks for data, a wait of more than 4 weeks for a web conference, or inconsistencies in the data sent after shown once (e.g., duplicate cases).

The customized Excel file for data remains copyrighted by Franklin Dexter. The file cannot be used for any purpose other than to send data to him.

To perform analyses #8 to #12, the data must include either the times of start and end of continuous anesthesia care or the times of patient entrance and exit from their OR. If it were identified that these fields are not available (i.e., planned consult cannot be performed) after initiation of the staffing analysis, the University will charge $1000 for time spent. To perform the other analyses, the data must include either the room in which each case was performed (i.e., “turnover times” are assessed for each room) or the anesthesia provider performing the case (i.e., “turnover times” are assessed for each provider’s list of cases). The data must include the surgeon and the surgical specialty, not just the facility. The data must include an “urgent” field, “emergent” field, or ASA physical status “E” code.

Should the preceding staffing analyses be included in the Scope of Services?

No

Decision making shortly before and on the day of surgeryTopics covered in the adapted scenarios include the following items:

Definitions of OR management terms using scientific literature (e.g., what is “turnover time”?) Scheduling add-on cases Allocating and scheduling an urgent / flexible / open OR Moving cases from one OR to another on the day of surgery Day of surgery decisions (e.g., what OR should I start first?) Scheduling delays between cases Scheduling elective cases into ORs to maximize OR efficiency Time up to when elective cases can be scheduled Releasing OR time allocated based on OR efficiency Allocating OR time to maximize OR efficiency Incorporating qualitative data in allocating OR time (e.g., expected maternity leave) Allocating OR time for surgeons performing few cases Staff budgeting linked to OR allocations and staffing

Approximately 45 scenarios are written using the data sent for the staffing analyses. The scenarios contain your physicians’ names, OR numbers, scheduled start times, holidays, etc. The resulting table of contents, explanations for each of the above topics, adapted scenarios, and bibliography serve as the revised OR policy manual.

Page 4

The scenarios are sent as a PDF file setup with protection for a needs assessment of changes in OR decision-making. A few OR managers, schedulers, and clinicians review each scenario to determine whether it matches current practice. Scenarios matching current practice are deleted. In less than one hour, the small set (e.g., 3 to 5) of remaining scenarios show changes necessary to achieve the maximum possible increase in OR efficiency. The remaining scenarios themselves are the customized materials for obtaining information from organizational stakeholders needed to decide on how best to implement changes.

The University charges $4000 for the adapted scenarios. The educational materials provided remain copyrighted by Franklin Dexter. Permission is granted for reproduction and distribution of them at the facility, provided that the copyright is displayed, there is no commercial redistribution, and the materials are not posted in whole or in part on any Internet (i.e., public, not Intranet) web site.

An educational session with Dr. Dexter using the customized materials is charged at $250 per hour. The scenarios are designed to appear nicely during web conferences.

Should scenario creation be included in the Scope of Services?

No

On-going assessment of staffing, operations, and decision-makingOR allocations are generally reassessed every four months. Training in interpreting the results of the analyses is updated each period during a web conference. The University charges $3750 to repeat the staffing and operational analyses. Outsourcing the on-going analysis can help physicians appreciate that decisions are data-driven, and not biased by informal, local, agreements. The most advanced scientifically sound methodology is being applied to your organization to keep your ORs as efficient as possible. In addition, internal analysts do not need to purchase the software, maintain the software, retain skills in using it even though it may only be three times a year, nor follow the scientific literature to update their knowledge.

A new assessment is performed only upon e-mail (written) request. Repeating analyses, creating customized reports, and/or having additional meetings would be billed at a rate of $250 per hour of Dr. Dexter’s time, charged to the nearest minute. There would also be $250 charge(s) for a wait of more than 4 weeks for data, a wait of more than 4 weeks for web conference, or inconsistencies in the data sent after shown once (e.g., duplicate cases).

Should the on-going assessment be included in the Scope of Services?

No

Phase I post-anesthesia care unit (PACU) staffing and operational assessmentThe assessment first considers the PACU length of stay, including a breakdown by type of anesthesia. The percentage impact of delays in discharge on total PACU length of stay of all patients is calculated, and accordingly the influence on total PACU nurse staffing.

Phase I PACU staffing is optimized to satisfy all ASPAN guidelines while reducing the percentage of days with at least one delay in admission from the OR into the PACU. For example, ideally each new PACU nurse would ideally work according to a schedule that would cause the largest reduction in the risk of delays in admission. However, there are so many schedule options that neither experience nor manual use of spreadsheets is practical to determine the best possible staff schedule. For example, consider a PACU with 14 nurses working daily in overlapping 8-hour, 10-hour, and 12-hour shifts. Between 8 AM and 11 PM, there are 18 potential shifts beginning at hourly intervals. Consequently,

Page 5

there are 1814 or more than 1000 trillion different possible scheduling solutions!

Every possible combination of specified shifts is considered as potential staffing solutions. The algorithm uses the number of available nursing hours to find the staffing solution with the fewest number of understaffed days. If a patient must wait in an OR for PACU admission at any time during a given day, then that day is considered understaffed. Because the software reproduces patient flow over a period of several months, the fraction of understaffed days is related statistically to the chance that any future day will be understaffed.

Calculations are based on historical data supplied by each hospital. Two types of data are needed: Dates and times of day that each patient waits in the OR for a bed in the PACU, and dates and times of day that each patient is admitted and discharged from the PACU. Such information is usually available from PACU billing data. In addition, the nurse: patient staffing ratio must be supplied for each patient if we cannot make the assumption that the majority of patients fit an acuity or staffing ratio of 1 nurse: 2 patients. These data are entered into labeled columns of worksheets that are supplied to the facility. Detailed instructions are supplied with all worksheets. If the acuity information is not available, a one-week survey is sufficient.

The mathematics identifies ways to change PACU nursing staffing so that as many patients can receive care with the same nursing hours, without increasing the risk of a day with a delay in PACU admission. There is a marked improvement in the achievable increase in productivity by increasing from 20 to 80 historical workdays of data, slight but statistically significant improvement between 80 and 100 days, but no significant improvement in further increasing the number of workdays of data. Therefore, 100 workdays of data are usually used (i.e., around 5 months).

A report is sent by e-mail as a PDF file. A written summary of the interpretation of each page of the report is included in the e-mail. Alternatively, the report is summarized during a web conference lasting approximately 45 minutes. The University charges $2500.

The customized Excel file sent to transfer data remains copyrighted by Franklin Dexter, and cannot be used for any purpose other than to send data to him. There would be $250 charge(s) for a wait of more than 4 weeks for the data or web conference. Analyses are generally reassessed every four months. The University charges $1750 to repeat the PACU analysis.

Should PACU staffing be included in the Scope of Services?

No

Meetings and presentations on-siteThe service-specific staffing analyses and scenario creation can be performed off-site, with explanation provided by web conference. Some organizations prefer an on-site visit.

Example of trip to assess anesthesia staffing and plan implementation of improvements

½ day Preparation Arrange travel plansPhone meeting and e-mail to arrange presentation objectives and printing of lecture handouts from the results of the staffing analysesPrepare presentation and review with a few managers ahead of time

1 day Day #1 Travel, during which complete preparationEvening presentation of results with anesthesia providers

1 day Day #2 2 hr meetings with administrators about results and implementation2 hr meetings with analysts on information system implementation

Page 6

2 hr meetings with OR and PACU nursing director and managers2 hr evening meeting with anesthesia providers and administrators

1 day Day #3 Travel, during which prepare assessment of anesthesia servicesFinish recommendations on how organization of anesthesia services could potentially foster surgical growth, and send within 4 days.

The University would charge $8,750 for the 3.5 days of Dr. Dexter’s time, plus travel expenses.

Example of 3½ day trip for detailed instruction on how to apply best practices in OR management to decision-making at your surgical suite, using the analyses and scenarios created with your data

1 day Preparation Arrange travel plans

Phone meeting to arrange presentation order, type of conference room, audiovisual equipment, and printing of handouts

Prepare initial course and presentations from customized scenarios

Extensive web conference to review presentation with 1-2 manager(s) who have helped with analyses and scenario generation

½ day Day #1 Complete preparation while traveling

1 day Day #2 7 hr course, organized as: 2 hr, 15 min break, 2 hr, 45 min lunch, 2 hr.

2 hr discussion with participants on implementation plans including data transfer on a routine basis and desired reports

½ day Day #3 Meet with individual administrators and physicians to review the specific topic(s) of concern to each

½ day Day #3 Return home. While traveling, prepare e-mail with follow-up information requested by attendees.

The University would charge $8750 for the 3.5 days of Dr. Dexter’s time plus travel expenses.

Upon request, Dr. Dexter will provide a fixed price charge for work calculated based on $1250 for each ½ day. These daily charges are based on time from leaving hotel to return not exceeding 12 hours and with total hours of meetings not exceeding 10 hours. Travel time to/from a work site is charged as ½ day in each direction. Reimbursement for hotel chosen by the Recipient includes internet access. Flights less than 5 hours will be booked at the lowest upgradeable coach class fare. The lowest business class fare will be used for flights 5 hours or longer. Reimbursement for printing Dr. Dexter’s handout(s) is the responsibility of the Recipient.

To have the 3.5 day intensive course given on-site, schedule ½ day of preparation before travel, 3.5 days for the course, and the travel time. Detailed specifications will be provided for the room for the course, setup of tables for the small groups, internet access for the participants, etc. Unless preferred otherwise, Dr. Dexter will arrive 2 (USA) or 3 (international) days earlier to mitigate impact of travel disruption (e.g., weather or volcano).

The customized Excel file used for the course remains copyrighted by Franklin Dexter. The file cannot be used for any purpose other than to send case answers to him.

If due to an act of God or severe illness, injury, or family emergency, Dr. Dexter is unable to present a course, it is understood that the agreement may be cancelled or rescheduled by mutual agreement, and all parties shall be released from liability or damages hereunder.

Page 7

Should an on-site visit after analysis be included in the Scope of Services?

No, so I have skipped the below Table

Day AM/PM     

1 PM 1/2 day budget for travel2 AM      2 PM Insert suggested activities   AM         PM         AM         PM         AM         PM         AM         PM         AM         PM         AM         PM         AM         PM         AM 1/2 day budget for travel

     

Should an on-site visit before analysis be included in the Scope of Services?

No, so I have skipped the below Table Most of Dr. Dexter’s work is done at the office and trips are 3 days long. So, most trips can be done within 3 weeks of a request. If to prepare a draft agenda you want to know potential dates, contact Dr. Dexter at Franklin-Dexter@UIowa.edu. If you are not using the standard Professional Services Agreement, add 1 week for review.

Day AM/PM

     1 PM 1/2 day budget for travel2 AM      2 PM Insert suggested activities   AM         PM         AM         PM         AM         PM      

Page 8

   AM 1/2 day budget for travel     

Reducing hospital’s anesthesia costs

Opportunities for cost reduction include comparing induction times, emergence times, and drug costs among anesthesia providers, while quantifying their impacts on hospital costs and surgeons’ schedules. Solutions include implementing practice guidelines and informatics programs for reducing anesthesia drug costs.

Add 5 hours to an existing on-site consultation for anesthesia staffing. On one day, plan one 2-hour meeting with anesthesia providers and other stakeholders. Plan another 2-hour meeting with information systems personnel. On a subsequent day, plan one 1-hour meeting with senior anesthesia providers to discuss potential recommendation. In addition, budget 10 hours after the on-site visit is over for writing recommendations and multiple e-mails over several weeks to plan implementation. The University’s total charge will be $3750.

Should reductions in hospital anesthesia costs be included in the Scope of Services?

No

Non-operating room (non-OR) “satellite” staffing and case scheduling

Plan three individuals to learn how to implement the science: a clinician, a scheduler, and a systems programmer. Because implementation characteristically is done slowly over at least six months, work is done principally by e-mail. The University charges $250 per hour for Dr. Dexter’s time. A typical budget is 40 hours (i.e., $10,000).

Should non-OR anesthesia case scheduling be included in the Scope of Services?

No

Perioperative tactical decision-making (profitability analysis)If a facility is deciding “should more block time be allocated” to a group of surgeons and, if so, “how much more block time,” then this is the appropriate analysis. See “OR financial assessment for tactical decision-making” at www.FranklinDexter.net/consulting.htm for a brief summary and www.FranklinDexter.net/education.htm for a long talk.

An Excel file will be created with the estimated financial impact of different block time decisions. The constraint of limited intensive care unit beds will be included, if appropriate. The uncertainty in estimated contribution margins per OR hour will be calculated. Mean differences will be calculated for surgeons between their lengths of stay and DRG-adjusted national average lengths of stay. Data will be summarized by patients’ ages, payers, and counties of residence, as appropriate. E - mail will be   used to obtain feedback for desired “What if” analyses. Subsequently, a final Excel file will be sent. The University charges $4000 for the analysis.

As part of the work, the reason why OR utilization is not relevant to this decision will be reviewed. The steps of the analysis will be discussed. Based on feedback as to what points seem counter-intuitive, a small set of slides will be prepared and sent as a PDF file.

Page 9

Questions are sent regarding how the data are structured. Based on responses, an Excel file is customized into which the data are imported. Repeating analyses, creating customized reports, and/or having additional meetings would be billed at a rate of $250 per hour of Dr. Dexter’s time, charged to the nearest minute. There would also be $250 charge(s) for a wait of more than 4 weeks for data, a wait of more than 4 weeks for web conference, or inconsistencies in the data sent after shown once (e.g., duplicate cases). If it were decided that implant cost data and/or intensive care unit length of stays are not available (i.e., consult cannot be performed) after it is started, the University will charge $1000 for time spent.

Should financial analysis be included in the Scope of Services?

No

Hospital inpatient workload for tactical or strategic decision-making Data envelopment analysis can be applied to US state and national databases to compare hospitals’ production of surgery. The University charges $2000. Upon receipt of the appropriate data for DEA from the client hospital, a PDF file with results is generally created and sent by e-mail within 1 week.

The following are types of questions that are answered using the DEA analysis:

How does each specialty inpatient workload compare to the volume of other key specialties, based on statistical population distribution?

What would be the likely impact of hiring a new thoracic (or vascular, neurological, etc.) surgeon on the hospital's specialty workload?

Is thoracic surgery inpatient workload of 121 lung resections high or low compared to that of orthopedics’ 213 hip replacements, urology’s 132 nephrectomies, and cardiac surgery’s 304 coronary artery bypass grafts?

If a new urologist were recruited, would the hospital likely grow the practice and perform more surgery, or simply have another urologist?

Are there sufficient patients for each specialty residing close to the hospital? To what extent is inpatient specialty OR workload limited by population size as compared

to existing capacity or hospital visibility within the community? Orthopedic surgery has a very high contribution margin per operating room hour. Operating

room capacity is being expanded by running some ORs for 10 hr instead of 8 hr. Should the additional OR time be planned for orthopedics? Are there really more cases to be done?

After the PDF report is sent, these questions can be discussed by   e - mail . The University charges $250 per hour.

Similarity analysis uses state discharge abstract data to compare the surgical procedures performed at one hospital with those performed at every other hospital in its state or province. The University charges $4000. Unlike for the DEA, the state discharge abstract data are provided by the hospital. Upon receipt of the data, a PDF file with results is generally sent by e-mail within 1 week.

The following are examples of questions that are answered using similarity analyses:

Do other hospitals in the hospital’s primary market area perform the same types of procedures as the hospital for which the analysis is being performed? Do other hospitals in the primary market area compete with the hospital for the same patients or do the other hospitals perform types of procedures that are different from those of the hospital of interest?

Page 10

What other hospitals in the state are competitors? What other hospitals in the primary and secondary market areas perform the same types of procedures as the hospital of interest, such that the hospital is competing with those other hospitals for the same patients?

What opportunities for growth can be targeted by the hospital? What types of procedures are being performed in large numbers by other hospitals in the primary and secondary market areas? Which other hospitals are performing large numbers of procedures that could also be performed at the hospital?

Which other hospitals can be considered peer institutions for purposes of recruiting physicians and nurses, negotiating purchasing contracts and insurance reimbursement rates, comparing costs and charges, benchmarking lengths of stay and quality improvement initiatives, and evaluating volume and market share?

For what types of procedures are patients leaving the hospital’s primary or secondary referral areas to have their surgery elsewhere in the state?

Which hospitals located outside the hospital’s primary or secondary referral areas are performing surgery on patients who live within the region?

After the Excel file report is sent, these questions are discussed during a web conference.

Should an inpatient workload analysis be included in the Scope of Services?

No

Planned Professional Services Agreement Yes, University agreement will be used.