Original: $3,201,651 FACILITY NAME: McDonough County Hospital District

Transcription

1 STATE OF ILLINOIS HEALTH FACILITIES AND SERVICES REVIEW BOARD 525 WEST JEFFERSON ST. SPRINGFIELD, ILLINOIS (217) FAX: (217) DOCKET NO: H-8 BOARD MEETING: July 14, 214 PROJECT NO: PROJECT COST: Original: $3,21,651 FACILITY NAME: McDonough County Hospital District CITY: Macomb TYPE OF PROJECT: Substantive HSA: II PROJECT DESCRIPTION: The applicant (McDonough County Hospital District) is proposing to establish a 12-bed acute mental illness category of service (geriatric psychiatric unit) on the campus of McDonough County Hospital, Macomb. The cost of the project is $3,21,651. The anticipated project completion date is December 31, 216.

2 EXECUTIVE SUMMARY PROJECT DESCRIPTION: The applicant (McDonough County Hospital District) is proposing to establish a 12-bed acute mental illness category of service. The applicant states the unit will used to provide service to the geriatric population. The cost of the project is $3,21,651. The anticipated project completion date is December 31, 216. Current State Board rules do not distinguish between geriatric and adolescent acute mental illness care. On December 17, 213 the State Board approved Permit #13-63 to construct a threestory addition to the McDonough County Hospital and to renovate existing space at a cost of approximately $39,772,251. In addition the State Board also approved 1,295 GSF of shell space. At that time the applicant provided assurance to the State Board that they would submit an application for permit for approved shell space. This project (#14-18) proposes to build out that shell space. WHY THE PROJECT IS BEFORE THE STATE BOARD: This project is before the State Board because the project proposes to establish a category of service as required by Illinois Health Facilities Planning Act. PURPOSE: The applicants are proposing to establish a 12-bed geriatric psychiatric unit on the campus of McDonough County Hospital, due to the absence of this category of service in the immediate service area. The applicant notes the closest facility offering geriatric psychiatric services is in Galesburg (59 minutes away). The establishment of this category of service will increase accessibility for this category of service in Macomb and McDonough County. NEED: There is a calculated excess of 36 Acute Mental Illness (AMI) beds in the Health Planning Area 2, per the June 214 Revised Bed Need Determination. However there is an absence of this specialized psychiatric service in the immediate service area, and the closest facility offering this service is in Galesburg (59 minutes away). TABLE ONE Facilities closest to McDonough County Hospital District Hospital City Time AMI Utilization (min) Beds Galesburg Cottage Hospital Galesburg % Blessing Hospital Quincy % Methodist Medical Center Peoria % Proctor Community Hospital Peoria % Memorial Medical Center Springfield % OSF Saint Elizabeth Medical Center Ottawa % 2

3 FINDINGS: The applicants addressed a total of 18 criterion and did not meet the following: State Board Standards Not Met Criteria Reasons for Non-Compliance (a) - Size of the Project The applicant exceeds the State Board Standard by 298 GSF per bed. The applicant stated Approximately 23.7% of the space proposed for the shell space is corridor space 2,443 GSF, another 657 GSF is for activity rooms, and 1,243 GSF are for offices waiting rooms and staff space which would normally be considered non clinical. That leaves 5,961 GSF for what could be considered to be nursing unit space. This amounts to GSF per bed, which compares favorably to the State Norm, which is GSF per bed. 3

4 STATE BOARD STAFF REPORT McDonough County Hospital District PROJECT #14-18 Applicant McDonough County Hospital District Facility Name McDonough County Hospital Location Macomb, Illinois Application Received April 3, 214 Application Deemed Complete April 3, 214 Can Applicants Request a Deferral? Yes I. The Proposed Project The applicants are proposing to establish a 12-bed acute mental illness category of service of McDonough County Hospital, Macomb. The estimated cost of the project is $3,21,651. The anticipated project completion date is December 31, 216. II. Summary of Findings A. The State Board Staff finds the proposed project DOES NOT appear to be in conformance with the provisions of Part 111. B. The State Board Staff finds the proposed project appears to be in conformance with the provisions of Part 112. III. General Information The applicant is McDonough County Hospital District. McDonough County Hospital District is located at 525 E. Grant Street, Macomb, Illinois in the HSA II Service Area and the Acute Mental Illness Planning Area 2. HSA II and the acute mental illness planning area includes the Illinois counties of Bureau, Fulton, Henderson, Knox, LaSalle, Marshall, McDonough, Peoria, Putnam, Stark, Tazewell, Warren, and Woodford. The licensee operating entity and owner of the site is McDonough County Hospital District. There are four hospitals in the Acute Mental Illness Planning Area 2 that provide acute mental illness services. The June 214 Revised Bed Determination indicates a calculated excess of 36 Acute Mental Illness beds in the Acute Mental Illness Planning Area 2. The estimated start-up costs/operating deficit for this project is $1,945,287. This is a substantive project subject to a Part 111 and Part 112 review. Project obligation will occur after permit issuance. 4

5 IV. Summary of Support and Opposition Letters No public hearing was requested and no letters of opposition were received by the State Board Staff. V. The Proposed Project - Details The applicant is proposing to establish a 12-bed acute mental illness category of service at McDonough Hospital District. The cost of project is $3,21,651. VI. Project Costs and Sources of Funds The applicant is funding this project with cash and securities of $3,21,651. Debt is not being used to fund this project. TABLE TWO Project Costs and Sources of Funds USE OF FUNDS CLINICAL New Construction Contracts $2,325,193 Contingencies $164,38 Architectural/Engineering Fees $24,229 Consulting and Other Fees $133,192 Movable or Other Equipment $375, TOTAL USES OF FUNDS $3,21,651 SOURCE OF FUNDS CLINICAL Cash and Securities $3,21,651 TOTAL SOURCES OF FUNDS $3,21,651 VII. Cost Space Chart The applicant is proposing a total of 1,295 GSF of space for this service. TABLE THREE Cost Space Chart Department Cost Proposed New As Is Vacated GSF Construction AMI Unit $3,21,651 1,295 1,295 Total Clinical $3,21,651 1,295 1,295 5

6 VIII. Section Project Purpose, Safety Net Impact and Alternatives A) Criterion (b) - Purpose of the Project The applicant shall document that the project will provide health services that improve the health care or well-being of the market area population to be served. The applicant shall define the planning area or market area, or other, per the applicant's definition. The applicants stated the following regarding the purpose of the project. The purpose of the proposed project is to establish a Geriatric Psychiatric Unit in an area of the State of Illinois which does not presently have any inpatient psychiatric services. The primary service area for the proposed project is a 4- mile circle surrounding the hospital which has a total population of 41,716 individuals above the age of 64, based upon the 21 Census with a projected population of 46,974 individuals above the age of 64 by CY 216. There are currently no hospitals in the proposed primary service area which offer any inpatient psychiatric services, and in discussions with the Senior citizens groups, the nursing home providers and the psychiatrists in the area the need for Geriatric Psychiatric Services was determined to be an area of need which was not being met with existing services. The closest facility offer the AMI service is Galesburg Cottage Hospital located in Galesburg, which, according to Map Quest, is 59 minutes from the applicant facility. By establishing the proposed service at the hospital it will be possible for patients from the service area to more easily access the needed Geriatric Psychiatric services, and by working with Horizon Health to manage the unit, the resources needed to provide a high quality service are greatly enhanced. Horizon Health is a national provider of AMI services and will be able to assist in the recruitment and training of the staff for the proposed unit. Several letters of support from the community are attached to the application which demonstrates the community support for the project. These letters also support the difficulty patients now have in accessing these types of services in the service area. The proposed project will meet the service area need for service in. a cost effective efficient manner. 6

7 B) Criterion (b) - Safety Net Impact Statement All health care facilities, with the exception of skilled and intermediate longterm care facilities licensed under the Nursing Home Act [21 ILCS 45], shall provide a safety net impact statement, which shall be filed with an application for a substantive project (see Section 111.4). Safety net services are the services provided by health care providers or organizations that deliver health care services to persons with barriers to mainstream health care due to lack of insurance, inability to pay, special needs, ethnic or cultural characteristics, or geographic isolation. [2 ILCS 396/5.4] The applicant stated the following: Since the applicant is the only licensed hospital within a 25 mile radius, the applicant facility is critical to providing a safety -net for the residents of Macomb and a large part of the surrounding area. The only other licensed hospital in the Board designated planning area is Graham Hospital located in Canton, Illinois which is more than 3 minutes travel time from the applicant facility. No other hospital could readily step in to serve the residents of McDonough County and the surrounding area. The applicant facility is the safety net hospital for this area and its continued existence is essential to high quality care to this planning area. The table below addresses the safety net requirements of the State Board. TABLE FOUR Safety Net Information per PA Net Revenue $55,367,87 $6,53,816 $63,66,317 CHARITY CARE Charity (# of patients) Inpatient Outpatient Total Charity (cost In dollars) Inpatient $181,457 $252,56 $346,734 Outpatient $44,231 $54,535 $826,384 Total $585,688 $757,95 $1,173,118 Charity Care % of Net Revenue 1.6% 1.25% 1.86% MEDICAID. Medicaid (# of patients) Inpatient Outpatient 7,57 8,149 9,191 Total ,421 9,442 Medicaid (revenue) Inpatient $3,548,243 $3,192,458 $3,188,528 Outpatient $8,451,894 $9,941,633 $1,911,746 7

8 TABLE FOUR Safety Net Information per PA Total $12,,137 $13,134,71 $14,1,274 Medicaid % of Net Revenue 21.67% 21.71% 22.36% C) Criterion (c) - Alternatives to the Proposed Project The applicant shall document that the proposed project is the most effective or least costly alternative for meeting the health care needs of the population to be served by the project. The applicant stated the following: Once the decision was made to establish a Geriatric Psychiatric unit the alternatives considered were to either utilize existing space now occupied by Medical Surgical beds or to utilize the shell space approved on the second floor of the new building. Both of these alternatives required the same amount of construction cost for the new addition, but the cost of relocating the Medical Surgical beds and modernizing the space to house an AMI unit makes that alternative more expensive. While the consideration of the relocation alternative never got to the level of preparing drawings and getting cost estimates from construction companies, past experience would put that cost in excess of $1,, in order to meet code requirements and provide for the safety of the facility's patients. This additional cost was also a factor in choosing the proposed project. The alternative of utilizing existing space was rejected for several reasons. Since the applicant facility is so isolated from other medical services it was determined that the number of Medical Surgical beds, which the applicant now has after the approval of the hospital modernization, was the number needed to assure that the facility would have a bed available in an emergency in order to avoid going on by-pass. Therefore, the Medical Surgical beds would have to be replaced by developing the shell space for Medical-Surgical beds rather than AMI beds which would not result in cost savings to the hospital and would then separate the Medical Surgical Service into two distinct areas of the hospital and would place the AMI service in a more congested area of the hospital. The existing space also would not be easily converted to the treatment and counseling space needed to support the AMI (Geriatric Psychiatric Service). The open shell space provided the best location for the proposed unit for several reasons: 1. The unit is separate from the other bed units in the hospital. 2. The space is large enough to allow for the 12 bed unit and the necessary support space, as well as the therapy and treatment space needed for the service. 8

9 3. The location near the emergency department allows for efficient transfer of patients needing AMI services to the new unit as well as allowing ED staff access to the expertise of the AMI staff should the need arise. 4. The location of the new unit will also allow easy access for patient visitors and family who are often involved in the treatment process. The alternative of doing nothing was also considered, but was rejected due to the increasing number of Geriatric Patients who need AMI services and the complete lack of those services within a reasonable travel time of the applicant facility It was also considered to be not feasible to build a separate addition to the hospital just to house the proposed AMI unit based upon the need to expand the hospital as a whole and the ability to accommodate the proposed unit within the confines of that modernization project. The alternative chosen of using the proposed shell space was determined to be the most cost effective method of providing this much needed new service IX. Section Project Scope and Size, Utilization A) Criterion Size of Project 1) The applicant shall document that the physical space proposed for the project is necessary and appropriate. The following table shows the project's square footage versus the State Norms: TABLE FIVE Size of the Project Proposed GSF State Standard Difference 12 Bed AMI Unit 1,295 GSF GSF//Bed 6,72 GSF 298 GSF/Bed The applicant is proposing a total of 1,295 GSF for the 12 bed unit. This exceeds the State Board Standard by 298 GSF per bed. The applicant stated in regards to the GSF overage The proposed project will utilize shell space previously approved by the State Board on December 17, 213. The shell space totaled 1,295 GSF. The total space was determined by the footprint of the building, the first floor houses the new emergency Department which was the driver for the original project. The space proposed consists of 12 private bed rooms, with private bathrooms; the general support space for those 12 bed, i.e., nurses station clean and soiled utilities, a nourishment area and all of the other areas required by licensure and accreditation agencies. In addition there are offices for the directors of the program; a staff break room, a family waiting area and activity rooms for the patients of the unit. Some of these areas under normal circumstances would be 9

10 considered non-clinical and not subject to Board review. However, in this instance where they are going to be occupying shell space which the applicant assured the Board would be brought back before the Board for its approval, the applicant included as clinical space so that a review could be conducted. Approximately 23.7% of the space proposed for the shell space is corridor space 2,443 GSF, another 657 GSF is for activity rooms, and 1,243 GSF are for offices waiting rooms and staff space which would normally be considered non clinical. That leaves 5,961 GSF for what could be considered to be nursing unit space. This amounts to GSF per bed, which compares favorably to the State Norm, which is GSF per bed. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT DOES NOT APPEAR TO BE IN CONFORMANCE WITH THE SIZE OF THE PROJECT CRITERION (77 IAC (a)). B) Criterion (b) - Project Services Utilization The applicant shall document that, by the end of the second year of operation, the annual utilization of the clinical service areas or equipment shall meet or exceed the utilization standards specified in Appendix B. The applicant is proposing to contract Horizon Health to operate the AMI unit at the Hospital. Horizon Health operates facilities throughout the country and has developed formulas for calculating the need for beds in a specific area. Using the 4 mile circle around the hospital and the 21 census figures it is estimated that the population, age 64 and older, for primary and secondary service area for this service totaled 41,718 in 21. The Inventory of Health Care Facilities published by the Illinois Health Facilities and Services Review Board projects an increase in that age group in HSA 2 to be 2.1 % annually. Based upon this projection, the applicant calculated that the population of the age 64 and over age group would be 46,974 in 216 when this project is completed and reaches the target occupancy level of 85%. The case projection coefficient cases per month per person is.537 which means that on average patients per month would require care in the proposed facility. Based upon an average length -of stay of 13.5 days per admission * * the annual number of patient days would total 4,86.4 in 216 which is an average daily census of patients. This indicates a need for beds. The applicant chose a more conservative number of beds and chose to develop a 12 bed unit. Based upon the above calculations the applicant can achieve the 85% occupancy rate by 216. Even if the population projections are not included the base line number of beds need is or 12 beds. 1

11 X. Section Acute Mental Illness Review Criteria a) Introduction 1) This Section applies to projects involving Acute Mental Illness (AMI) and Chronic Mental Illness (CMI). Applicants proposing to establish, expand or modernize AMI and CMI categories of service shall comply with the applicable subsections of this Section, as follows: PROJECT TYPE Establishment of Services or Facility REQUIRED REVIEW CRITERIA (b)(1) & (3) Background of the Applicant (c)(1) (c)(2) (c)(3) (c)(5) (d)(1) (d)(2) (d)(3) (f) (g) (h) Planning Area Need 77 Ill. Adm. Code 11 (formula calculation) Planning Area Need Service to Planning Area Residents Planning Area Need Service Demand Establishment of AMI and/or CMI Planning Area Need Service Accessibility Unnecessary Duplication of Services Maldistribution Impact of Project on Other Area Providers Staffing Availability Performance Requirements Assurances 11

12 B) Criterion (b) - Background of Applicant 1) An applicant must demonstrate that it is fit, willing and able, and has the qualifications, background and character to adequately provide a proper standard of health care service for the community. [2 ILCS 396/6 The applicant does not own any other health care facilities and has attested that no adverse action has been taken by either a federal or state agency. The applicant also attested that the State Board may access any documentation that the State Board deems pertinent to the application for permit. The applicant has provided the necessary documentation that addresses this criterion at pages of the application for permit. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT TO BE IN CONFORMANCE WITH BACKGROUND OF APPLICANT CRITERION (77 IAC C) Criterion (c) - Planning Area Need The applicant shall document that the number of beds to be established or added is necessary to serve the planning area's population. 1) 77 Ill. Adm. Code 11 (Formula Calculation) A) The number of beds to be established for each category of service is in conformance with the projected bed deficit specified in 77 Ill. Adm. Code 11, as reflected in the latest updates to the Inventory. 2) Service to Planning Area Residents A) Applicants proposing to establish or add beds shall document that the primary purpose of the project will be to provide necessary health care to the residents of the area in which the proposed project will be physically located (i.e., the planning or geographical service area, as applicable), for each category of service included in the project. 3) Service Demand Establishment of AMI and/or CMI The number of beds proposed to establish a new AMI and/or CMI service is necessary to accommodate the service demand experienced by the existing applicant facility over the latest two-year period, as evidenced by historical and projected referrals, or, if the applicant proposes to establish a new hospital, the applicant shall submit projected referrals. D) Patient Type 12

13 The applicant shall identify the type of patients that will be served by the project by providing the clinical conditions anticipated (e.g., eating disorder, borderline personality disorder, dementia) and age groups (e.g., childhood, adolescent, geriatric) targeted. 5) Service Accessibility The number of beds being established or added for each category of service is necessary to improve access for planning area residents. The applicant is proposing to establish a 12 bed acute mental illness service to care for geriatric patients in the Acute Mental Illness Planning Area 2. There is a calculated excess of 36 acute mental illness beds in this planning area. Currently the State Board does not distinguish between geriatric or adolescent AMI beds. The primary service area for the proposed project also is the primary planning area for hospital as a whole with the majority of the applicant's patients being located within the boundaries of HSA 2. HSA 2 includes the Illinois counties of Bureau, Fulton, Henderson, Knox, LaSalle, Marshall, McDonough, Peoria, Putnam, Stark, Tazewell, Warren, and Woodford. There are no other hospitals with 25 miles of the applicant s facility and no hospitals within 45 minutes of the hospital which offer AMI services. The closest hospital offering AMI services is Galesburg Cottage Hospital in Galesburg which, according to MapQuest is 59 minutes travel time from the applicant s facility. The hospital's primary purpose is to serve the residents of a large area in West central Illinois which currently do not have ready access to AMI services. The applicant did not provide referral letters to estimate the number of patients to be served by the AMI service. Instead the applicant projected the number of patients based upon the 21 census, average annual increase in the over 64 age group of 2.1 annually, and the historical experience of the Horizon Health in estimating the number of patients to be served. The applicant estimated that the population of the 64 and over age group to be 46,974 in 216 in HSA 2. The case projection coefficient per month per person is.537*** which means that on average 25 patients per month would need the care provided by this 12 bed unit. (See application for permit page 55 for a complete discussion). There is a calculated excess of 36 acute mental illness beds in this planning area by CY 215. However the acute mental illness service is not available within 3 minutes of the proposed site. It would appear that the proposed service is needed and that access would be improved with the establishment of this service. 13

14 THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT TO BE IN CONFORMANCE OF PLANNING AREA NEED CRITERION (77 IAC (c)) D) Criterion (d) - Unnecessary Duplication/Maldistribution Review Criterion 1) The applicant shall document that the project will not result in an unnecessary duplication. 2) The applicant shall document that the project will not result in maldistribution of services. 3) The applicant shall document that, within 24 months after project completion, the proposed project: A) Will not lower the utilization of other area providers below the occupancy standards specified in 77 Ill. Adm. Code 11; and B) Will not lower, to a further extent, the utilization of other area hospitals that are currently (during the latest 12-month period) operating below the occupancy standards. As can be seen by the Table below there are no AMI beds within 3 minutes of the proposed site. While there is an excess of AMI beds in HSA 2 of 36 beds there are no beds within 3 or 45 miles of the applicant s facility. The closest hospital which provides AMI services is 59 minutes from the proposed unit. Therefore there does not appear to be any unnecessary duplication of services in this area or a maldistribution of service. Given the distance from other providers it does not appear that the proposed service will lower the utilization of other providers of AMI service. TABLE SIX Hospitals with AMI service closest to the Applicant Hospital City Time AMI Utilization Beds Galesburg Cottage Hospital Galesburg % Blessing Hospital Quincy % Methodist Medical Center Peoria % Proctor Community Hospital Peoria % Memorial Medical Center Springfield % OSF Saint Elizabeth Medical Center Ottawa % THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT TO BE IN CONFORMANCE WITH THE UNNECESSARY 14

15 DUPLICATION OF SERVICE/MALDISTRIBUTION CRITERION (77 IAC (d)) E) Criterion (f) - Staffing Availability The applicant shall document that relevant clinical and professional staffing needs for the proposed project were considered and that licensure and Joint Commission staffing requirements can be met. In addition, the applicant shall document that necessary staffing is available by providing letters of interest from prospective staff members, completed applications for employment, or a narrative explanation of how the proposed staffing will be achieved. The applicant provided a narrative at page 58 of the application for permit that details the process the applicant will use to recruit staff for this 12 bed unit. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT TO BE IN CONFORMANCE WITH THE STAFFING AVAILABILITY (77 IAC (f)) F) Criterion (g) - Performance Requirements Bed Capacity Minimums 1) The minimum unit size for a new AMI unit within an MSA is 2 beds. 2) The minimum unit size for a new AMI unit outside an MSA is 1 beds. The applicant is not located within an MSA; therefore the unit size meets the requirements of this criterion. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT TO BE IN CONFORMANCE WITH THE PERFORMANCE REQUIREMENTS-BED CAPACITY CRITERION (77 IAC (g)) G) Criterion (h) -Assurances The applicant representative who signs the CON application shall submit a signed and dated statement attesting to the applicant's understanding that, by the second year of operation after the project completion, the applicant will achieve and maintain the occupancy standards specified in 77 Ill. Adm. Code 11 for each category of service involved in the proposal. 15

16 The applicant provided the necessary assurance at page 7 of the application for permit that the proposed AMI unit will be at target occupancy of 85% by the second year of operation. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT TO BE IN CONFORMANCE WITH THE PERFORMANCE REQUIREMENTS-BED CAPACITY CRITERION (77 IAC (g)) XI. Section Availability of Funds The applicant shall document that financial resources shall be available and be equal to or exceed the estimated total project cost plus any related project costs by providing evidence of sufficient financial resources. The applicant is funding this project with cash and securities. The applicant provided a letter from BMO Private Bank that documents that the applicant has requested a discretionary distribution in the amount of $4,, from Fellkelmer Trust- McDonough District Hospital. These funds are to be used towards the establishment of a 12-bed inpatient geriatric psychiatric unit in a newly constructed space at McDonough District Hospital. Given the parameters of the trust BMO Harris Bank as Trustee, has approved the request for a $4,, distribution from the Trust. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT APPEARS TO BE IN CONFORMANCE WITH THE AVAILABILITY OF FUNDS CRITERION (77 IAC ). XII. Section Financial Viability The applicant shall document that the applicants are financially viable. Because the applicant is funding the transaction from a trust (cash and securities) the applicant has qualified for the financial viability waiver. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT APPEARS TO BE IN CONFORMANCE WITH THE FINANCIAL VIABILITY CRITERION (77 IAC ). XIII. Section Economic Feasibility A) Criterion (a) - Reasonableness of Financing Arrangements The applicant shall document the reasonableness of financing arrangements. There is no debt associated with this project; the applicant has met the requirements of this criterion. 16

17 THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT APPEARS TO BE IN CONFORMANCE WITH THE REASONABLENESS OF FINANCING ARRANGEMENTS CRITERION (77 IAC (a)). B) Criterion (b) - Conditions of Debt Financing This criterion is applicable only to projects that involve debt financing. The applicant shall document that the conditions of debt financing are reasonable. There is no debt associated with this project; the applicant has met the requirements of this criterion. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT APPEARS TO BE IN CONFORMANCE WITH THE CONDITIONS OF DEBT FINANCING CRITERION (77 IAC (b)). C) Criterion (c) - Reasonableness of Project and Related Costs The applicant shall document that the estimated project costs are reasonable and shall document compliance with the State Board Standards. New Construction and Contingency Costs These costs are $2,489,231 or $ per GSF. This appears reasonable when compared to the State Board Standard of $ Contingency Costs These costs are $164,38 or 7.5% of modernization costs. These costs appear reasonable when compared to the State Board Standard of 1-15%. Architectural and Engineering Fees These costs are $24,229 or 8.2% of new construction and contingency costs. This appears reasonable when compared to the State Board Standard of 6.89%-1.35% Movable Equipment These costs are $37,. The State Board does not have a standard for these costs. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT APPEARS TO BE IN CONFORMANCE WITH THE REASONABLENESS OF PROJECT COSTS CRITERION (77 IAC (c)). D) Criterion (d) - Projected Operating Costs The applicant shall provide the projected direct annual operating costs (in current dollars per equivalent patient day or unit of service) for the first full fiscal year at target utilization but no more than two years following project completion. Direct costs mean the fully allocated costs of salaries, benefits and supplies for the service. 17

18 The projected operating costs per equivalent patient day are $2,99. The applicants have met this criterion. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT APPEARS TO BE IN CONFORMANCE WITH THE PROJECTED OPERATING COSTS CRITERION (77 IAC (d)). E) Criterion (e) - Total Effect of the Project on Capital Costs The applicant shall provide the total projected annual capital costs (in current dollars per equivalent patient day) for the first full fiscal year at target utilization but no more than two years following project completion. The total effect of the Project on Capital Costs is $4.9 per equivalent patient day. THE STATE BOARD STAFF FINDS THE PROPOSED PROJECT APPEARS TO BE IN CONFORMANCE WITH THE TOTAL EFFECT OF THE PROJECT ON CAPITAL COSTS CRITERION (77 IAC (e)). 18

19 Hospital Profile - CY 212 McDonough District Hospital Macomb Ownership, Management and General Information Patients by Race ADMINISTRATOR NAME: Kenny Boyd ADMINSTRATOR PHONE OWNERSHIP: MCDONOUGH COUNTY HOSPITAL DISTRICT OPERATOR: MCDONOUGH COUNTY HOSPITAL DISTRICT MANAGEMENT: Hospital District CERTIFICATION: (Not Answered) FACILITY DESIGNATION: General Hospital ADDRESS 525 East Grant Street CITY: Macomb Clinical Service Medical/Surgical -14 Years Years Years Years 75 Years + Pediatric Intensive Care Direct Admission Transfers White # 96.4% Black # American Indian # Obstetric/Gynecology Maternity Clean Gynecology 8 11 Neonatal Long Term Care Swing Beds Acute Mental Illness Rehabilitation Dedcated Observation Authorized CON Beds 12/31/ Peak Beds Setup and Staffed Facility Utilization Data by Category of Service Peak Census Admissions Inpatient Days 1,355 4, , , , %.% Page 1 Patients by Ethnicity Hispanic or Latino: Not Hispanic or Latino: Unknown: Asian #.4% Hawaiian/ Pacific #.% IDPH Number: 1438 Unknown.5% HPA C-4 HSA 2 COUNTY: McDonough County Observation Days (Includes ICU Direct Admissions Only) Average Length of Stay Inpatients and Outpatients Served by Payor Source Average Daily Census % 99.8%.% Staffed Bed Occupancy Rate % Facility Utilization 94 2,278 9, Inpatients Outpatients Medicare Medicaid Other Public Private Insurance Private Pay Charity Care 44.2% 16.%.% 26.% 9.% 4.8% Totals 37.9% 14.1%.2% 4.8% 6.1%.9% ,655 Financial Year Reported: 7/1/211 to 6/3/212 Inpatient and Outpatient Net Revenue by Payor Source Total Charity Charity Care Expense Medicare Medicaid Other Public Private Insurance Private Pay Totals Care 1,14,133 Inpatient 5.6% 8.4%.% 33.% 8.% 1.% Expense Revenue ( $) Outpatient Revenue ( $) 9,252,761 1,527,63 6,37,42 1,467,667 18,285, , % 4.1%.% 68.2% 1.9% 1.% CON Occupancy Rate % Long-Term Acute Care.... 7,482,75 1,838,314 3,56,658 4,899,162 44,78, , % 2,278 Total Charity Care as % of Net Revenue Birthing Data Number of Total Births: 332 Number of Live Births: 33 Birthing Rooms: Labor Rooms: Delivery Rooms: Labor-Delivery-Recovery Rooms: 3 Labor-Delivery-Recovery-Postpartum Rooms: C-Section Rooms: CSections Performed: 15 Newborn Nursery Utilization Level 1 Patient Days 737 Level 2 Patient Days 44 Level 2+ Patient Day Total Nursery Patientdays 781 Laboratory Studies Inpatient Studies 49,2 Outpatient Studies 141,554 Studies Performed Under Contract 15,769 Organ Transplantation Kidney: Heart: Lung: Heart/Lung: Pancreas: Liver: Total:

20 Hospital Profile - CY 212 Surgical Specialty Cardiovascular Dermatology General Gastroenterology Neurology OB/Gynecology Oral/Maxillofacial Ophthalmology Orthopedic Otolaryngology Plastic Surgery Podiatry Thoracic Urology McDonough District Hospital Macomb Surgery and Operating Room Utilization Operating Rooms Surgical Cases Surgical Hours Inpatient Outpatient Combined Total Inpatient Outpatient Inpatient Outpatient Total Hours Page 2 Hours per Case Inpatient Outpatient Totals SURGICAL RECOVERY STATIONS Stage 1 Recovery Stations 6 Stage 2 Recovery Stations 9 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 Non-Dedicated Rooms Emergency/Trauma Care Certified Trauma Center No Level of Trauma Service Level 1 (Not Answered) Level 2 Not Answered Operating Rooms Dedicated for Trauma Care 2 Number of Trauma Visits: Patients Admitted from Trauma Emergency Service Type: Basic Number of Emergency Room Stations 9 Persons Treated by Emergency Services: 14,384 Patients Admitted from Emergency: 1,438 Total ED Visits (Emergency+Trauma): 14,384 Outpatient Service Data Total Outpatient Visits 164,955 Outpatient Visits at the Hospital/ Campus: 145,43 Outpatient Visits Offsite/off campus 19,912 Cardiac Catheterization Utilization Total Cardiac Cath Procedures: Diagnostic Catheterizations (-14) Diagnostic Catheterizations (15+) Interventional Catheterizations (-14): Interventional Catheterization (15+) EP Catheterizations (15+) 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 : Cardiac Catheterization Labs Total Cath Labs (Dedicated+Nondedicated labs): Cath Labs used for Angiography procedures Dedicated Diagnostic Catheterization Lab Dedicated Interventional Catheterization Labs Dedicated EP Catheterization Labs Diagnostic/Interventional Examinations Equipment Owned Contract Inpatient Outpt General Radiography/Fluoroscopy 7 15,85 Nuclear Medicine Mammography Ultrasound Angiography ,394 5,63 1,932 Diagnostic Angiography Interventional Angiography Positron Emission Tomography (PET) Computerized Axial Tomography (CAT) Magnetic Resonance Imaging 1 1 4,785 Contract 1,529 Radiation Equipment Therapies/ Owned Contract Treatments Lithotripsy 1 25 Linear Accelerator Image Guided Rad Therapy Intensity Modulated Rad Thrp High Dose Brachytherapy Proton Beam Therapy Gamma Knife Cyber knife Source: 212 Annual Hospital Questionnaire, Illinois Department of Public Health, Health Systems Development.

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