COMMUNITY REPORT. Luis Reyes Double Bypass

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1 On my way to the office, I felt a chest pain and my seven months pregnant wife drove me to Osceola Regional where Dr. Sanchez did a Cardiac catheterization procedure and recommended a Triple by-pass surgery. Today I have a full recovery, exercising with Cardio rehab (Thanks Maggy!) and enjoying my life with my wife Judith, my newborn Anabella and my kids Jose, Carla and Nichole. Luis Reyes Double Bypass Above all else, we are committed to the care and improvement of human life. In recognition of this commitment, we strive to deliver high quality, cost effective healthcare in the communities we serve COMMUNITY REPORT

2 Our Commitment To Excellence A Message From Our CEO: It is with great pleasure that I present our Annual Community Report In the past two years since I have joined this magnificent facility, I have been continuously impressed with Osceola Regional s team of committed professionals who deliver the highest quality patient care every day. I am proud to report that such efforts have been recognized. On June 6, 2012, the Orlando Sentinel published a front page story on Safe Hospital Scores conducted by The LeapFrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits. The scores were derived from Leapfrog s key questions and publicly reported data. Osceola Regional Medical Center received an A rating for safety, the highest rating awarded by the group placing Osceola Regional as only 1 of 3 A hospitals in Central Florida. I encourage our community to visit to learn more about the study and what it means to have an A hospital close to home. Besides our great strides in safe and high quality patient care, Osceola Regional has greatly impacted Osceola County and the surrounding communities with our latest innovations in emergency heart care such as Radial Access STEMI a heart catheterization procedure in select patients to unblock a heart vessel during a heart attack through the wrist, versus the groin area. Our Central Florida Cardiac and Vascular Institute has earned, once again, the highest 3-Star rating for cardiac surgery excellence by The Society of Thoracic Surgeons recognition that places your community cardiovascular program in the top 13% nationally. We are expeditiously progressing with Poinciana Medical Center construction with a planned opening summer In addition, we are simultaneously making headway in our new 60-bed patient tower construction to meet the demands of our growing population and house our Orthopedic and Spine Center as well as our Cancer Program, which has been awarded accreditation with six commendations by the American College of Surgeons Commission on Cancer. Another exciting accomplishment that we are proud of is our re-accreditation for our Advanced Primary Stroke Center the only one offered in Osceola County. In addition, the American Heart and Stroke Association presented the Gold Plus Performance Achievement Award for consistent quality stroke care for the past three years and the Silver Performance Achievement Award for heart failure. I am extremely proud of what we have achieved and even more excited about our continued commitment to providing the highest, innovative and accessible quality care right in your community. Looking to a promising future, Sincerely, Kathryn J. Gillette, CEO Chief Executive Officer

3 Osceola Regional Medical Center HCA Central Florida Facilities H H HOSPITALS CENTRAL FLORIDA REGIONAL HOSPITAL Sanford, Florida OSCEOLA REGIONAL MEDICAL CENTER Kissimmee, Florida FUTURE SITE: POINCIANA MEDICAL CENTER Poinciana, Florida SURGERY CENTERS FLORIDA SURGERY CENTER Altamonte Springs, Florida KISSIMMEE SURGERY CENTER Kissimmee, Florida MERRITT ISLAND SURGERY CENTER Merritt Island, Florida SAME DAY SURGICENTER OF ORLANDO Orlando, Florida IMAGING CENTERS OSCEOLA IMAGING & BREAST CARE CENTER Kissimmee, Florida MT. D O R A Osceola Regional Medical Center Leadership 429 A P O PKA 429 WALT D I S NEY WORLD Kathryn J. Gillette Chief Executive Officer Glenn Romig Chief Financial Officer David Cashwell Chief Operating Officer Sonya Quintana Chief Nursing Officer Aida Sanchez Jimenez, MD Chief Medical Officer ALTAMONTE S P R INGS W INTER PA R K O R L A N D O H K I S S I M M E E 2 91 P O I N C I A N A 1 H 1 S ANFO RD 46 L A K E MAR Y 92 4 LAKE MONROE Osceola Regional Medical Center Services Accreditations and Certifications: Accredited Hospital (Joint Commission) Accredited Cancer Program (Commission on Cancer) ACCREDITED Chest Pain Center with pci (SCPC) Certified Advanced Primary Stroke Center (Joint Commission) Additional Services: 24-HOUR EMERGENCY SERVICES 24-HOUR OB PHYSICIAN CONCIERGE THE BABY SUITES BREAST CARE CENTER CARDIOVASCULAR HYBRID OR CENTRAL FLORIDA CARDIAC & VASCULAR INSTITUTE COMPANY CARE OCCUPATIONAL HEALTH KISSIMMEE PHYSICAL THERAPY CENTER AND REHABILITATION MINIMALLY INVASIVE VALVE SURGERY NEONATAL CARE LEVEL II ORTHOPEDIC & SPINE CARE CENTER OSCEOLA IMAGING CENTER PEDIATRIC ER PROGRAM ROBOTIC SURGERY WOUND HEALING CENTER & HYPERBARIC MEDICINE I m thankful for every day because it s good. First of all, I thank my heavenly Father. And for keeping my heart working, I thank Dr. Kumar. Mona Dene Hart Cardiac Patient, 2 Stents 2012 COMMUNITY REPORT 1

4 Our Commitment To Excellence 2011 Community Impact Summary Statistics Number of Licensed Beds Total Patients Treated Annual Hospital Admissions Annual Emergency Visits Total Medicaid Patients Treated Medicaid Market Share Total Uninsured Patients Treated 1 Uninsured Market Share ,364 18,083 81,058 37, % 19, % (1) excludes Medicaid patients treated Our Hospital Family Total Employees Total Physicians Total Volunteers 1, Mended Hearts has been offering hope and encouragement to heart patients, families and caregivers for over 50 years. We re hoping to keep that tradition alive right here in Osceola county with as much outreach and support as possible. 2 Community Impact

5 Osceola Regional Medical Center Economic Impact Total Salaries & Benefits Cost of Charity & Uncompensated Care Taxes Paid: Federal Income Tax State Income Tax Indigent Care Tax Property Tax Sales Tax Other Local Tax Total Taxes Capital Investment 1 Total Local Vendor Support Minority & Women Owned Business Support Physician Specialty Coverage for Emergency Care TOTAL Economic Impact $ 105,223,219 $ 33,184,890 $ 1,867,949 $ 344,778 $ 3,277,537 $ 1,723,399 $ 1,363,836 $4,127 $ 8,581,626 $ 8,242,082 $ 20,028,993 $ 154,023 $ 4,278,616 $ 179,539,426 (1) 5 year annual average FY 2011 statistics Local Vendor Support 11% Physician Specialty Coverage for Emergency Care 2% Capital Investment 5% Total Taxes 5% Total Cost of Charity & Uncompensated Care 18% Total Salaries & Benefits 59% 2012 COMMUNITY REPORT 3

6 Our Commitment To Excellence A partial list of the organizations benefitting from Osceola Regional Medical Center s involvement: American Cancer Society American Diabetes Association American Heart Association Blood Bank Boy Scouts of America Community Redevelopment Agency Community Vision Council of Aging Downtown Kissimmee Area Council Economic Development Councils Habitat for Humanity HCA Hope Fund Help Now! Hispanic Business Council Junior League of Greater Orlando Junior Achievement Kissimmee Main Street Kissimmee/Osceola County/St. Cloud/ Lakeland/South Lake/Winter Haven Chamber of Commerce Leadership Osceola Local Medical Societies March of Dimes Meals on Wheels Osceola County Housing Authority Osceola Education Foundation Park Place Behavioral Health Poinciana Area Council Rotary Sunshine Foundation Susan G. Komen For The Cure United Way Valencia Community College YMCA GIVING BACK TO OUR COMMUNITY Community Support Osceola Regional Medical Center and our employees provide both financial and volunteer support to countless civic organizations, schools, colleges, city projects and nonprofit and charitable organizations in our local communities. Additionally, our hospital sponsors a wide range of community health information programs, screenings and seminars, which are posted on hospital websites in the community calendar section. Here, too, you can find our online physician directory, listing by specialty or name search, physicians who are credentialed to be on the hospital s medical staff. Indigent Patient Education The hospital is committed to helping uninsured patients qualify for local and state health benefit programs. Osceola Regional offers onsite benefit education and Medicaid enrollment assistance. Going Green As an active member of the Practice Greenhealth, an industry leader in sustainable, ecofriendly practices, Osceola Regional Medical Center is involved with green initiatives both at the facility level and in many cases in the greater community. It is part of our commitment to have a comprehensive environmental strategy in concert with our mission of the care and improvement of human life. Social & Mobile Media Osceola Regional now has a social media presence to engage our patients and the communities we serve as fully as possible. Links to Facebook, Twitter and other channels can be found on our hospital website. Volunteering Countless hours of volunteering were performed by members of the Osceola Regional Medical Center family last year. Our staff, volunteers and physicians give back to our communities, both in and outside of our facilities. Osceola Regional Team at the 2011 American Heart Association Heart Walk. 4 Giving Back To Our Community

7 Osceola Regional Medical Center Awards and Recognition Our facility and management team continue to receive awards and recognition for the outstanding medical care and services we provide as well as the leadership role we play in our community. Our hospital is proud to be Joint Commission Accredited, an Accredited Chest Pain Center with PCI and a Certified Advanced Primary Stroke Center by the Joint Commission. The American Heart and Stroke Association has also given Osceola Regional the Get With The Guidelines Gold Plus Performance Achievement in Quality Stroke Care and Silver Quality Achievement Award for Heart Failure. Additionally, Osceola Regional has earned the Blue Distinction Center for Cardiac Care, Blue Distinction for Spine Surgery, Blue Distinction Center for Knee and Hip Replacement and the United Health Premium Designation for Cardiac. Osceola Regional also received the three-year accreditation with six commendations to the Cancer Program, granted by the Commission on Cancer (CoC) of the American College of Surgeons (ACoS). Also, Central Florida Cardiac and Vascular Institute has been awarded for the second time the highest Three-Star recognition by the nation s leading heart surgery society, The Society of Thoracic Surgeons, placing our Cardiac Surgery Program in the nation s top 13 percent. Lastly, Osceola Regional is one of the few local facilities certified in carotid stenting by the Centers of Medicare and Medicaid Services. Osceola Regional Medical Center recently received an A rating for safety by The LeapFrog Group, the highest rating awarded by the group placing Osceola Regional as only 1 of 3 A hospitals in Central Florida. HOSPITAL SAFETY For Excellence In Cardiac Surgery The highest award given by The Society of Thoracic Surgeons. Accredited Chest Pain Center w/pci Primary Stroke Center Certification Health Partners Osceola Regional Medical Center partners with a wide range of resources, including HealthGrades and itriage, to bring our communities the latest health information quickly and conveniently. For information on downloading the itriage mobile application, visit our hospital website at Hurricane Preparedness Osceola Regional offers one of the most comprehensive hurricane preparedness plans to ensure that our patients and our staff who care for them are safe before, during and after a storm. Our hospital has arrangements and contracts in place with vendors from around the state and nation to provide support, from on-site security if needed to medical supplies, additional generators, food, fuel, emergency transportation, building supplies and construction crews who can be dispatched immediately following the storm to make needed repairs to keep our hospital operational. Emergency communications, several days worth of food and supplies all arrive at our facility well in advance of a storm to ensure the hospital is self-sustaining for several days. Transfer processes and plans are in place with our network of HCA hospitals from around the country should patients need to be relocated. Consult-A-Nurse Free Physician Referral and Health Information are available around the clock by calling Registered Nurses are available for consultation through this bi-lingual community service, which also registers people for the numerous community education classes and programs sponsored by Osceola Regional Medical Center COMMUNITY REPORT 5

8 Our Commitment To Excellence Quality & Patient Safety Putting Patients First is the foundation of our culture and passion for quality health care. Many of the initiatives we implement serve as national models for the industry today. The HCA West Florida hospitals have achieved industry leading performance on public Clinical Measures, such as the CMS Core Measures for Congestive Heart Failure, Pneumonia, Acute Myocardial Infarction, and Surgical Care Improvement Project. Our hospitals are thoroughly engaged in programs and initiatives which promote and optimize Patient Satisfaction, Clinical Efficiency programs and Quality outcomes. AIM for Zero AIM for Zero is an example of Osceola Regional s commitment to providing excellence in healthcare through the consistent application of evidence-based interventions in the elimination of Central Line-Associated Blood Stream Infections (CLA-BSI). Osceola Regional s goal for this initiative is zero, as we know from the medical literature that these infections are increasingly proven to be avoidable. The letter A in AIM stands for antimicrobial stewardship which embraces the effective and efficient utilization of antibiotics. Overuse of broad spectrum antibiotics is not only needlessly expensive, but it breeds resistant infections. The letter I refers to a checklist of interventions that has been demonstrated as preventing CLA-BSI at the point of Insertion. M stands for vigilance in maintaining and removing central lines at the earliest appropriate moment. Culture is critical to high performance healthcare. AIM for Zero includes behavioral expectations that encourage any team member to speak up to assure that the required interventions are followed. The personal behavior choices caregivers make each day affect their ability to protect patients from preventable, and potentially life-threatening, infections. Through exemplary leadership and support, Osceola Regional Medical Center is committed to offering the premier performance patients expect and deserve. Airstrip OB & Cardiology This innovative patient monitoring solution has been installed at our hospital to allow obstetricians to remotely access vital patient information such as fetal heart rate including maternal contraction patterns in virtual real-time directly from the labor & delivery unit to a physician s smartphone from anywhere a cell phone connection can be received. As a result of our success with the OB monitoring program, we expanded into the cardiology program which provides physicians immediate access to cardiac monitoring from their smartphone. Broselow System for Acute Pediatric Administration of Drugs in the ER Our hospital emergency department uses the Broselow System to ensure the proper dosing and administration of drugs to children. Pediatric dosing can be difficult, especially in emergency situations, and the Broselow System allows medical professionals to instantly access proper dosing, improve the speed and accuracy in acute preparation and administration of drugs, reduce medical errors and standardizes pediatric dosing so that we can provide our young patients with high quality emergency care, safely. 6 Quality & Patient Safety

9 Osceola Regional Medical Center Flu Season Preparation Influenza remains the number one cause of vaccine-preventable death in the United States. Infected health workers can infect others and we want to eliminate that risk. Any death from a disease that is vaccine-preventable is one too many. HCA employees have received national recognition for their commitment to patient safety for their efforts in supporting HCA s flu immunization policy. This flu season our goal is the same a commitment to 100 percent patient safety. The way we will achieve this goal is through vaccination of health workers with direct patient contact or wearing a mask when vaccine is not possible. hcare Electronic Health Record (EHR) Osceola Regional Medical Center has invested heavily in its Electronic Health Record (EHR) initiatives. With EHR, access to patient health information is simplified and patient safety and quality improved. Our hospital has brought numerous clinical components for the EHR on-line through major investments in technology. As of 2011, physicians are able to document and enter patient orders online and remotely from their offices. This streamlines the ordering process and ensures accurate and timely approach to patient care. As more physician practices use Electronic Medical Record (EMR) systems, there is an increased need to integrate data from a variety of clinical systems, including hospital systems. Linking physician practices to our hospital database will be launched through the hcare Hub interface. This allows physician offices real-time access to patient clinical data from the hospital. Effective clinical data exchange can provide necessary information to physicians to make timely decisions and reduce duplicate testing and unnecessary hospitalizations. Medical Education Osceola Regional Medical Center s leadership believes that the future of the State of Florida and, in particular Central Florida s healthcare system, depends on well trained physicians fully engaged in the safety and well being of patients and is committed to deliver this mission. Together with area partners, Osceola Regional Medical Center will be applying to sponsor residents in Internal Medicine and General Surgery and looks forward to grow in number and diversity of residency programs. The hospital will be working diligently to sponsor medical residents in the next two years. Medical Research The Central Florida Cardiac & Vascular Institute at Osceola Regional Medical Center is now a major cardiovascular clinical research strategic site, affiliated with the Sarah Cannon Research Institute (SCRI) of Nashville COMMUNITY REPORT 7

10 Our Commitment To Excellence MRSA ABC s A new strain of antibiotic-resistant staph, or MRSA, is spread easily and is much more difficult to treat than ordinary staph bacteria. The growing prevalence of MRSA in our communities and in our hospitals is creating new challenges for the healthcare community. In response, HCA hospitals across the nation, under the leadership of Dr. Jonathan B. Perlin, HCA s chief medical officer, have implemented more aggressive infection prevention protocols to tackle this issue. HCA facilities have also been provided with a proactive education campaign for patients, visitors and staff to prevent infections from occurring and spreading. We see MRSA as a national challenge affecting hospitals and communities alike, and would like to share our materials as a way of contributing to the education and more importantly the eradication of MRSA. Please feel free to use the tools from our MRSA campaign, available on our hospital websites, at home, work, or school, and join us in the fight to eradicate MRSA. Nation s First Infant Screening Program HCA was the first US healthcare system to voluntarily perform a simple blood test to screen newborns for elevated levels of bilirubin that triggers jaundice. By identifying newborns at risk for Kernicterus, which causes permanent brain damage and physical impairment, we can treat them immediately and prevent this serious health threat. Responsible Imaging The Osceola Regional imaging department has state-of-the-art equipment that provides a lower patient dose. The department has a team of highly qualified members, all state board certified physicians and a registered technologist, who are highly proficient in their field. As part of the HCA West division we have adopted the Radiation Right initiative that promotes patient safety in medical image. We support and coordinate activities designed to reduce radiation dose while maintaining appropriate standards of imaging quality. We ensure that referring clinicians have the resources and incentives to make appropriate decisions in the ordering of procedures, and raise public awareness of the uses, benefits, and risks of medical imaging. Our imaging department sponsors the Image Wise campaign established by the American College of Radiology to promote radiation safety in adults and Image Wisely promoting radiation protection and safety in children. We are committed to a higher standard of care and protection following the ALARA (As Low As Reasonably Achievable) policy established by the American Registry of Radiology Technologists. Vitals Now Vitals Now technology enables the automatic capture of patient vitals right from the bedside into our main Clinical System. This enhances clinical decision making for our care givers as patient vitals are now readily available in the patient s record. 8 Quality & Patient Safety / Specialized Care

11 Osceola Regional Medical Center Specialized care Accredited Cancer Care Cancer is the second leading cause of death in this country, exceeded only by heart disease. Our hospital is committed to quality care by striving to meet and exceed the many standards required for the American College of Surgeons Commission on Cancer (ACoS CoC) Accreditation. Osceola Regional Medical Center achieved the Accredited Cancer Center designation this year from the ACoS CoC with six commendations. Since most cancer patients require multiple types of treatment, good communication between providers is essential. One of the best ways to accomplish this is through tumor board reviews, where a variety of medical specialists including surgeons, medical oncologists, radiation oncologists, pathologists, radiologists and hospital clinical and support staff meet regularly to proactively review patient cases. Advanced technology is another commitment with our hospitals providing patients the latest in everything from digital mammography for early detection to minimally invasive surgery for treatment. Robotic technology is taking surgery beyond the limits of the human hand, introducing precise, versatile instrument movement combined with the ability to see a three-dimensional visualization of the operative site. Osceola Regional Medical Center utilizes The da Vinci Robotic System. Our comprehensive robotic program offers multiple specialties such as: thoracic surgery, gynecologic, gynecologic oncology, urology and colorectal surgery. Emergency Excellence Our strong focus on enhancing emergency care and improving processes continues to keep our ER wait times below national averages, but more importantly we are exceeding national guidelines in delivering care quickly, when it matters most. STEMI time averages, along with wait time averages, are now featured on our hospital website. Osceola Regional is Chest Pain Accredited with Percutaneous Coronary Intervention (PCI) and has earned certification by the Joint Commission as an Advanced Primary Stroke Center the only two centers in Osceola County. Protocol driven care that can begin in the field through direct communications with local EMS teams are all part of our commitment to improve quality in our busy emergency department. One of our latest innovations in emergency heart care is Radial Access Stemi a catheterization procedure in select patients to unblock a heart vessel during a heart attack through the wrist versus the groin area. One of our specialized emergency services is our Pediatric ER program, which consists of literally taking the fear out of the experience for children up to age 18 and their parents. Board certified Pediatric ER physicians, specially trained nurses in pediatric emergency care, and pediatric advanced life support focus on minimizing pain for children experiencing any invasive procedure such as shots, stitches, etc. Check out our excellent pediatric average er wait times on our website at COMMUNITY REPORT 9

12 Our Commitment To Excellence Heart & Vascular The Central Florida Cardiac & Vascular Institute of Osceola Regional Medical Center ensures that life-saving technology and the latest minimally invasive techniques are available in our communities. As an Accredited Chest Pain Center with PCI, we are consistently beating the national STEMI benchmark of 90 minutes, dramatically improving the lives of our patients experiencing a heart attack. The latest surgical techniques for vascular, minimally invasive mitral valve and atrial fibrillation repair provide a safer alternative for patients suffering from these conditions, improving their quality of life and reducing their risk for other serious complications. Our Cardiac Cath and EP labs offer state-of-the-art technology and treatments for invasive and noninvasive cardiac procedures. Additionally, our hospital offers a specialized chest pain unit where patients can be rapidly assessed and diagnosed without having to be admitted to the hospital. Osceola Regional Medical Center has signed an agreement with Sarah Cannon Research Institute, one of the largest clinical research programs in the nation, to be a major cardiovascular clinical research strategic site. This agreement will allow the Central Florida Cardiac & Vascular Institute to expand its cardiovascular research program and offer physicians and patients the opportunity to participate in clinical trials locally. Cardiovascular Hybrid Operating Room combines an operating suite with a cardiac catheterization laboratory (cath lab) and peripheral angiographic imaging capabilities. This allows the patient to undergo a cath procedure followed by an open heart procedure in the same room. The institute is home to the only true hybrid OR in Central Florida. Our Institute received certification and recognition for the outstanding care it provides by receiving the highest 3 Star rating from The Society of Thoracic Surgeons (STS) for quality care in cardiac surgery, placing the program in the nation s top 13 percent. Neurosciences & Stroke Care Osceola Regional Medical Center has earned Joint Commission certification as an Advanced Primary Stroke Center, the gold standard for ensuring the highest level of care is immediately available. As the only Advanced Primary Stroke Center in Osceola County, Osceola Regional is especially proud to have earned the distinguished Gold Plus Performance Achievement Award by the American Heart and Stroke Association for following and exceeding guidelines in stroke key measures for three consecutive years. Treating more than 900 cases a year, the stroke team consists of emergency medicine physicians, neurologists, radiologists, CT technologists, phlebotomists, neurology nurses and therapists and local emergency responders who are dedicated to the rapid recognition, evaluation and treatment of stroke patients, using the latest guidelines and technology to ensure optimal patient outcomes. 10 Specialized Care

13 Osceola Regional Medical Center Orthopedics & Spine Surgery Osceola Regional provides a comprehensive, multidisciplinary approach to the treatment of patients with total joint replacement and spinal surgery. The hospital has been recognized as a Blue Distinction Center for Knee and Hip Replacement and a Blue Distinction Center for Spine Surgery. Our surgeons are committed to performing the latest innovations in their field with advanced orthopedic procedures including minimally invasive partial and total knee and hip resurfacing. Our spine orthopedic surgeons and neurosurgeons perform he most minimally invasive procedures available today, with outstanding outcomes and greatly reduced hospital stays. The Orthopedic & Spine Center is designed for optimal comfort following surgery with surgeons supported by a professional team of specially trained nurses, physical therapists, pain management experts, case managers and dietitians to focus on wellness and quick recovery. The hospital also offers special amenities and private rooms to encourage a quick return to everyday activities and immediate family involvement in the recovery process. Imaging Services Osceola Regional Medical Center provides a comprehensive array of inpatient and outpatient imaging services. We are committed to offering imaging services needed across the full continuum of a patient s care and to Responsible Imaging, which includes a number of patient safety practices such as using the lowest reasonably achievable utilization of medical radiation during exams that involve radiation. The Osceola Imaging Center features a full range of outpatient diagnostic imaging services and offers convenience by providing walk-in appointments, minimal wait times, free accessible parking, and a professional and bilingual healthcare staff to assist you with your healthcare needs. Osceola Imaging Center houses the Breast Care Center, which offers women advanced screening and diagnostic technology in a convenient and comfortable setting. The Breast Care Center is also accredited by the American College of Radiology. Diagnostic services available at the hospital include: n CT Scan n Digital Mammography n Echocardiogram n EKG n Fluoroscopy n Interventional Angiography n MRA/MRI on a 1.5 Magnet n Nuclear Medicine n Ultrasound n X-Ray Diagnostic Services at the Osceola Imaging & Breast Care Center include: n Breast MRI n CT Scan n DEXA/Bone Densitometry n Digital Mammography n 3T MRI Magnet n MRI-Guided Biopsy n Ultrasound-Guided Biopsy n Ultrasound n X-Ray IMAGING & BREAST CARE CENTER Osceola Regional Medical Center 2012 COMMUNITY REPORT 11