STATE OF ILLINOIS HEALTH FACILITIES AND SERVICES REVIEW BOARD

Transcription

1 STATE OF ILLINOIS HEALTH FACILITIES AND SERVICES REVIEW BOARD WEST JEFFERSON ST. SPRINGFIELD, ILLINOIS (217) FAX: 217) DOCKET ITEM: BOARD MEETING: EXEMPTION NUMBER: E-1 March 26, 213 E-2-13 EXEMPTION APPLICANT(S): Northwestern Lake Forest Hospital, Northwestern Memorial HealthCare, Lake Forest Endoscopy Center, LLC Lake Forest Endoscopy Physician Group, LLC FACILITY NAME and LOCATION: Lake Forest Endoscopy Center, Grayslake I. The Exemption Application STATE AGENCY REPORT CHANGE OF OWNERSHIP EXEMPTION The applicants are proposing the transfer of 7% ownership of Lake Forest Endoscopy Center from Lake Forest Endoscopy Physician Group, LLC to Northwestern Lake Forest Hospital. At the conclusion of this transaction, Lake Forest Endoscopy Center will be a wholly owned corporation of Northwestern Lake Forest Hospital and will be dissolved upon completion of the transaction. The transaction involves a purchase resulting in the issuance of a license to an entity different from the current licensee. The licensee operating entity and the owner of the site will be Northwestern Lake Forest Hospital. The anticipated acquisition price is $5,52, and the anticipated completion date is upon State Board Approval. II. The Illinois Health Facilities Planning Act defines a change of ownership as... a change in the person who has ownership or control of a health care facility s physical plant and capital assets. A change in ownership is indicated by the following transactions: sale, transfer, acquisition, lease, change of sponsorship or other means of transferring control. The applicants are before the State Board because the transaction involves a change in control of a health care facility as defined by the Act. (2 ILCS 396) At the conclusion of this report is the 211 Annual ASTC Questionnaire for Lake Forest Endoscopy Center. Page 1

2 The applicants have met all of the requirements of 77 IAC Requirements for Exemptions Involving a Change of Ownership of a Health Care Facility. III. The Facility The Lake Forest Endoscopy Center is a limited specialty ambulatory surgical treatment center with 2 procedure rooms performing gastrointestinal procedures only. III. The Applicants The applicants are Northwestern Lake Forest Hospital, Northwestern Memorial HealthCare, Lake Forest Endoscopy Physician Group, LLC and Lake Forest Endoscopy Center, LLC. On July 24, 27, the State Board approved Project #7-43 for the establishment of Lake Forest Endoscopy Center a limited specialty ASTC, in Grayslake. At the time of the permit issuance, LFEC was comprised of five members: 4 individual physicians (Mark Blitstein, M.D. Trevor Lissoos, M.D., Frank Martini, M.D., Alexander Tosiou, M.D.) and Northwestern Lake Forest Hospital. The ownership structure was Northwestern Lake Forest Hospital with 3% ownership and each physician with 17.5% ownership. In May, 28, the four physician owners formed an Illinois limited liability company known as Lake Forest Endoscopy Physician Group, LLC. On December 1, 29, Project #9-38 was approved which transferred the ownership from the individual physicians to the new limited liability company. Northwestern Lake Forest Hospital ownership of 3% remained unchanged. At the end of 29, an additional physician, Tara Troy, M.D., was added to the Lake Forest Endoscopy Physician Group, LLC. In September, 212, Northwestern Lake Forest Hospital was informed by the Lake Forest Endoscopy Physician Group that they were in the process of selling their group practice and becoming employed by a Northwestern Medical Faculty Foundation a large multi-specialty physician group. As part of the original corporate structure, the Lake Forest Endoscopy Physician Group must allow Northwestern Lake Forest Hospital the right of first refusal to purchase their 7% share of the ASTC upon dissolution of their physician group. If this change of ownership is approved, Northwestern Lake Forest Hospital would have 1% ownership of the ASTC. At the end of this transaction, Lake Forest Endoscopy Center would be a wholly owned corporation of Northwestern Lake Forest Hospital and will be dissolved at the end of the accounts receivable run-out process. IV. The Proposed Transaction Page 2

3 All categories of service currently provided at Lake Forest Endoscopy Center will not substantially change for at least 12 months following the completion of the proposed transaction, and there will be no change resulting in the restriction of patient admissions or reductions in access to care. According to the applicants the proposed transaction will improve access to care by supporting future growth and will be able to support the formation of a broad network of integrated services. The applicants have certified that no adverse actions have been taken against them by the federal government, licensing or certifying bodies of the State of Illinois. The applicants have also certified that the facility will not adopt a more restrictive charity care policy than the policy that was in effect one year prior to the transaction. The applicants have provided certification that the compliant charity care policy will remain in effect for a two-year period, following the change of ownership transaction. The applicants also certify that they intend to maintain ownership and control of the facility for a minimum of three years and have sufficient financial resources to complete the transaction. The applicants state that the charity care policy and non-profit mission will be in place for Lake Forest Endoscopy Center s patients. Patients who meet the applicants charity care guidelines will be provided care regardless of their ability to pay. In addition, Lake Forest Endoscopy Center will be in compliance with all regulatory and JCAHO standards that are required. The purchase will allow the applicants to continue to provide a valued and needed service for the residents of central Lake County. VI. Other Information Included in the information submitted to the State Board is the change of ownership exemption application for the proposed change of ownership of Lake Forest Endoscopy Center. Page 3

4 AMBULATORY SURGICAL TREATMENT CENTER PROFILE-211 LAKE FOREST ENDOSCOPY CENTER, LLC GRAYSLAKE Reference Numbers Facility Id Health Service Area 8 Planning Service Area LAKE FOREST ENDOSCOPY CENTER, LLC 1475 EAST BELVIDERE ROAD, STE. 33 GRAYSLAKE, IL Number of Operating Rooms Procedure Rooms 2 Exam Rooms Number of Recovery Stations Stage 1 3 Number of Recovery Stations Stage 2 Administrator ALEXANDER TOSIOU Registered Agent Lynn Gordon Property Owner Lake Forest Hospital Outpatient Legal Owner Date Completed 2/27/212 Type of Ownership Limited Liability Partnership (RA required) HOSPITAL TRANSFER RELATIONSHIPS HOSPITAL NAME NUMBER OF PATIENTS STAFFING PATTERNS PERSONNEL FULL- EQUIVALENTS Administrator. Physicians. Nurse Anesthetists. Dir. of Nurses 1. Reg. Nurses 3. Certified Aides. Other Hlth. Profs. 2. Other Non-Hlth. Profs 2. TOTAL 8. DAYS AND HOURS OF OPERATION Monday 9 Tuesday 9 Wednesday 9 Thursday 9 Friday 9 Saturday Sunday Source:Ambulatory Surgical Treatment Center Questionnaire for 211, Illinois Department of Public Health, Health Systems Development Page 221 of 276 5/14/212

5 AMBULATORY SURGICAL TREATMENT CENTER PROFILE-211 LAKE FOREST ENDOSCOPY CENTER, LLC GRAYSLAKE NUMBER OF PATIENTS BY AGE GROUP AGE MALE FEMALE TOTAL ,5 1, Yea TOTAL 1,261 1,825 3,86 NUMBER OF PATIENTS BY PRIMARY PAYMENT SOURCE PAYMENT SOURCE MALE FEMALE TOTAL Medicaid Medicare Other Public Insurance 1,3 1,414 2,417 Private Pay Charity Care TOTAL 1,261 1,825 3,86 NET REVENUE BY PAYOR SOURCE FOR FISCAL YEAR Medicare Medicaid Other Public Private Insurance Private Pay TOTALS 17.%.1%.1% 82.9%.% 1.% 445,91 1,79 2,62 2,178,922 2,629,134 Charity Care Expense Charity Care Expense as % of Total Net Revenue % OPERATING ROOM UTILIZATION FOR THE REPORTING YEAR PREP and AVERAGE CLEAN-UP TOTAL CASE TOTAL AREA SURGERIES Cardiovascular.... Dermatology.... Gastroenterology.... General.... Laser Eye Surgery.... Neurological.... OB/Gynecology.... Ophthalmology.... Oral/Maxillofacial.... Orthopedic.... Otolaryngology.... Pain Management.... Plastic Surgery.... Podiatry.... Thoracic.... Urology.... TOTAL.... PROCEDURE ROOM UTILIZATION FOR THE REPORTING YEAR PREP and AREA PROCEDURE ROOMS TOTAL SURGERIES CLEAN-UP TOTAL AVERAGE CASE Cardiac Catheteriza. Gastro-Intestinal Laser Eye. Pain Management. TOTALS Source:Ambulatory Surgical Treatment Center Questionnaire for 211, Illinois Department of Public Health, Health Systems Development Page 222 of 276 5/14/212

6 Hospital Profile - CY 211 Northwestern Lake Forest Hospital Lake Forest Page 1 Ownership, Management and General Information Patients by Race Patients by Ethnicity ADMINISTRATOR NAME: Thomas McAfee White # 74.7% Hispanic or Latino: 8.6% ADMINSTRATOR PHONE: Black # 8.2% Not Hispanic or Latino: 91.4% OWNERSHIP: Northwestern Lake Forest Hospital American Indian #.1% Unknown:.% OPERATOR: Northwestern Lake Forest Hospital Asian # 2.1% IDPH Number: 123 MANAGEMENT: Not for Profit Corporation (Not Church-R Hawaiian/ Pacific #.4% CERTIFICATION: HPA A-9 # Unknown: 14.5% FACILITY DESIGNATION: General Hospital HSA 8 ADDRESS 66 North Westmoreland Road CITY: Lake Forest COUNTY: Lake County Clinical Service Medical/Surgical -14 Years Years Years Years 75 Years + Pediatric Intensive Care Direct Admission Transfers Authorized CON Beds 12/31/ Peak Beds Setup and Staffed 74 Admissions Inpatient Days Observation Days 5,397 19,776 1,972 Obstetric/Gynecology ,836 4,82 82 Maternity 1,71 4,483 Clean Gynecology Neonatal Long Term Care Swing Beds Acute Mental Illness Facility Utilization Data by Category of Service Peak Census , 3,32 1,85 6, ,756 1,589 6, , ,37 2, , ,626 Staff Bed Occupancy Rate % Rehabilitation.... Long-Term Acute Care.... Dedcated Observation Facility Utilization 25 9,63 48,695 2, Inpatients Outpatients (Includes ICU Direct Admissions Only) Inpatients and Outpatients Served by Payor Source Medicare Medicaid Other Public Private Insurance Private Pay Charity Care 34.5% 5.8% 2.4% 53.2% 1.% 3.1% Totals 17.8% 9.3% 1.4% 68.1% 2.2% 1.3% ,235 Financial Year Reported: 9/1/21 to 8/31/211 Inpatient and Outpatient Net Revenue by Payor Source Total Charity Charity Care Expense Medicare Medicaid Other Public Private Insurance Private Pay Totals Care 1,221, Inpatient Expense 37.5% 2.9% 1.2% 56.4% 1.9% 1.% Revenue ( $) Outpatient Revenue ( $) Average Length of Stay Average Daily Census CON Occupancy 12/31/ ,741,78 2,85,21 863,582 4,25,877 1,375,356 71,316,85 3,347, 12.9% 2.8% 1.2% 79.% 4.% 1.% 19,56,327 4,297,78 1,829,9 119,195,91 5,956,426 15,785,641 6,874, 4.6% 9,63 Total Charity Care as % of Net Revenue Birthing Data Number of Total Births: 1,687 Number of Live Births: 1,682 Birthing Rooms: Labor Rooms: Delivery Rooms: Labor-Delivery-Recovery Rooms: 8 Labor-Delivery-Recovery-Postpartum Rooms: C-Section Rooms: 2 CSections Performed: 583 Freestanding Emergency Center Visits = 24,36 (Not included in hospital ER visit total) Newborn Nursery Utilization Level 1 Patient Days 3,577 Level 2 Patient Days 547 Level 2+ Patient Days 448 Total Nursery Patientdays 4,572 Laboratory Studies Inpatient Studies 21,16 Outpatient Studies 293,382 Studies Performed Under Contract 26,633 Organ Transplantation Kidney: Heart: Lung: Heart/Lung: Pancreas: Liver: Total:

7 Hospital Profile - CY 211 Northwestern Lake Forest Hospital Lake Forest Surgery and Operating Room Utilization Surgical Specialty Operating Rooms Surgical Cases Surgical Hours Inpatient Outpatient Combined Total Inpatient Outpatient Inpatient Outpatient Total Hours Cardiovascular Dermatology General Gastroenterology Neurology OB/Gynecology Oral/Maxillofacial Ophthalmology Orthopedic Otolaryngology Plastic Surgery Podiatry Thoracic Urology Totals SURGICAL RECOVERY STATIONS Stage 1 Recovery Stations 1 Stage 2 Recovery Stations 18 Page 2 Hours per Case Inpatient Outpatient Procedure Type Gastrointestinal Laser Eye Procedures Pain Management Dedicated and Non-Dedicated Procedure Room Utilzation Procedure Rooms Surgical Cases Surgical Hours Inpatient Outpatient Combined Total Inpatient Outpatient Inpatient Outpatient Total Hours Cystoscopy Hours per Case Inpatient Outpatient Multipurpose Multipurpose Non-Dedicated Rooms Cardiac Catheterization Labs Cardiac Catheterization Utilization Total Cath Labs (Dedicated+Nondedicated labs): 1 Total Cardiac Cath Procedures: 349 Cath Labs used for Angiography procedures Diagnostic Catheterizations (-14) Dedicated Diagnostic Catheterization Labs Diagnostic Catheterizations (15+) 249 Dedicated Interventional Catheterization Labs Interventional Catheterizations (-14): Dedicated EP Catheterization Labs Interventional Catheterization (15+) 4 Emergency/Trauma Care EP Catheterizations (15+) 6 Certified Trauma Center Yes Level of Trauma Service Level 1 (Not Answered) Level 2 Adult Operating Rooms Dedicated for Trauma Care Number of Trauma Visits: 4,921 Patients Admitted from Trauma 387 Emergency Service Type: Comprehensive Number of Emergency Room Stations 17 Persons Treated by Emergency Services: 23,71 Patients Admitted from Emergency: 3,723 Total ED Visits (Emergency+Trauma): 27,992 Cardiac Surgery Data Total Cardiac Surgery Cases: Pediatric ( - 14 Years): Adult (15 Years and Older): Coronary Artery Bypass Grafts (CABGs) performed of total Cardiac Cases : Outpatient Service Data Total Outpatient Visits 2,235 Outpatient Visits at the Hospital/ Campus: 93,663 Outpatient Visits Offsite/off campus 16,572 Diagnostic/Interventional Equipment Examinations Owned Contract Inpatient Outpt Contract General Radiography/Fluoroscopy 13 11,445 4,892 Nuclear Medicine ,846 Mammography ,938 Ultrasound 18 2,61 22,112 Angiography 2 Diagnostic Angiography Interventional Angiography Positron Emission Tomography (PET) Computerized Axial Tomography (CAT) 8 4,357 18,48 Magnetic Resonance Imaging 7 1,275 11,63 Treatment Equipment Owned Contract Therapies/ Treatments Lithotripsy 2 99 Linear Accelerator 2 8,991 Image Guided Rad Therapy Intensity Modulated Rad Thrpy High Dose Brachytherapy Proton Beam Therapy Gamma Knife Cyber knife Source: 211 Annual Hospital Questionnaire, Illinois Department of Public Health, Health Systems Development.

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