National Economic Impact Survey. Market Research Report. Summer 2012

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1 National Economic Impact Survey Market Research Report Summer 2012

2 TABLE OF CONTENTS EXECUTIVE SUMMARY... 1 DETAILED FINDINGS... 6 APPENDIX LIMITATIONS DEFINITIONS QUESTIONNAIRE... 41

3 EXECUTIVE SUMMARY Key Findings by Objectives: 1. Top concerns that member facility faces in the current economic environment. Respondents indicate that the top concerns that their facilities face in the current economic environment are Reimbursement cuts, Impact on healthcare reform, and Reduced operating margins. 2. Level of recovery from the economic downturn. 37% of the respondents indicate that they have significantly improved financially from the economic downturn. 22% indicate that there is no change in financial situation, while 42% indicate that the financial situation has worsened. 3. Whether member facilities foresee an increase, decrease, or no change in staffing over the next year because of the economic environment. 12% of the respondents foresee an increase in staffing over the next year. 46% foresee a decrease, while 42% indicate that there is no change in staffing. 4. Areas where member facilities expect a staff increase in their facilities. A majority of respondents expect a staff increase in clinical (75%) and nursing (75%), followed by pharmacy (63%) and physicians (50%). 5. Areas where member facilities expect a staff decrease in their facilities. 90% of the respondents expect a staff decrease in support services, 61% expect a staff decrease in clinical and 48% expect a staff decrease in nursing. 6. Whether member facilities foresee an increase, decrease, or no change in supply spending over the next year at their facilities. 29% of the respondents indicate that they foresee an increase in supply spending over the next year at their facilities. 42% foresee a decrease, while 29% indicate that there is no change in supply spending. 7. The percentage that member facilities anticipate an increase in supply spending within their facilities. Of the 29% of the respondents who foresee an increase in supply spending over the next year at their facilities, 58% indicate that they anticipate an increase between 1 and 5 percent within their facilities. Member & Market Research 1 Summer 2012

4 8. The percentage that member facilities anticipate a reduction in supply spending within their facilities. Of the 42% of the respondents who foresee a decrease in supply spending over the next year at their facilities, 54% indicate that they anticipate a reduction between 6 and 10 percent within their facilities. 9. Whether member facilities foresee an increase, decrease, or no change in their facilities improvement and capital projects over the next year. 32% of the respondents foresee an increase in their facilities improvement and capital projects over the next year. 29% foresee a decrease, while 39% indicate that there is no change in their facilities improvement and capital projects. 61% of the respondents have a capital budget that is under $20M. 20% indicate that they have a capital budget that is $20-40M, while 7% have a capital budget of $40-80M. 13% of the respondents have a capital budget that is over $80M. 10. The percentage that member facilities anticipate an increase in capital spending. Of the 32% who foresee an increase in capital spending in their facilities over the next year, 35% indicate that they anticipate an increase between 0 and 5 percent in capital spending. Another 30% anticipate increases between 6 and 10 percent. 11. The percentage that member facilities anticipate a reduction in capital spending. Of the 29% who foresee a decrease in capital spending in their facilities over the next year, 64% anticipate a reduction between 0 and 10 percent in capital spending. 12. Whether member facilities foresee an increase, decrease, or no change in surgical procedures over the next year at their facilities. 43% of the respondents foresee an increase in surgical procedures over the next year at their facilities. 15% foresee a decrease while 42% indicate that there is no change in surgical procedures. Member & Market Research 2 Summer 2012

5 13. Types of surgical procedures where member facilities expect an increase. 68% of the respondents indicate that they expect an increase in knee (orthopedic) procedures, hip (orthopedic) procedures (61%), and back (orthopedic) procedures (50%). 14. Types of surgical procedures where member facilities expect a decrease. 50% of the respondents indicate that they expect a decrease in knee (orthopedic) procedures and hip (orthopedic) procedures. 15. Whether member facilities foresee an increase, decrease, or no change in spending on purchased or outsourced services. 15% of the respondents foresee an increase in spending on purchased or outsourced services. 14% foresee a decrease, while 71% indicate that there is no change in spending on purchased or outsourced services. 16. Whether member facilities expect their purchasing of new medical technology to increase, decrease, or no change over the next year 33% of the respondents expect their purchasing of new technology to increase over the next year. 16% expect a decrease, while 52% indicate that there is no change. 17. Whether member facilities expect their purchasing of new technology to increase, decrease, or no change over the next year. 58% of the respondents foresee an increase in IT infrastructure purchase over the next year at their facilities. 10% foresee a decrease, while 32% indicate that there is no change IT infrastructure purchase over the next year. 18. Whether member facilities foresee an increase, decrease, or no change in pharmacy spending over the next year at their facilities. 41% of the respondents foresee an increase in pharmacy spending over the next year at their facilities. 16% foresee a decrease, while 44% indicate that there is no change in pharmacy spending over the next year. 19. The factor(s) that are driving the increase in pharmacy spending over the next year. 73% of the respondents identify drug shortages as driving the increase in pharmacy spending over the next year. Another 69% indicate that Oncology-branded products drive the increase in pharmacy spending. Member & Market Research 3 Summer 2012

6 20. Areas where member facilities are focusing their efforts to reduce costs. 80% of the respondents indicate that they are focusing their efforts to reduce costs by standardization. Other areas where respondents are focusing their efforts to reduce costs are process improvement (77%), commitment to GPO (69%), renegotiating with vendors (64%), and utilization (61%). 21. Whether member facilities foresee an increase, decrease, or no change in spending on spinal products over the next year. 20% of the respondents indicate that they foresee an increase in spending on spinal products over the next year. 19% foresee a decrease, while 61% indicate that there is no change in spending on spinal products. 22. Why member facilities indicated that there would be a/an increase/decrease/no change in spending on spinal procedures over the next year. 100% identified aging population as one of the reasons why there would be an increase in spending on spinal procedures. 50% identified product cost as one of the reasons for a decrease. 23. Whether member facilities foresee an increase, decrease, or no change in spending on orthopedics products over the next year. 39% of the respondents indicate that they foresee an increase in spending on orthopedics products over the next year. 28% foresee a decrease, while 33% indicate that there is no change in spending on orthopedics products. 24. Why member facilities indicated that there would be a/an increase/decrease/no change in spending on orthopedics products over the next year. 85% identified aging population as one of the reasons why there would be an increase in spending on orthopedics products. 53% of respondents identified product cost as one of the reasons for a decrease. 25. Whether member facilities foresee an increase, decrease, or no change in spending on cardiology products over the next year. 33% of the respondents indicate that they foresee an increase in spending on cardiology products over the next year. 22% foresee a decrease, while 45% indicate that there is no change in spending on cardiology products. Member & Market Research 4 Summer 2012

7 26. Why member facilities indicated that there would be a/an increase/decrease/no change in spending on cardiology products over the next year. 68% identify the procedure growth as one of the reasons why there would be an increase in spending on cardiology products. 37% indicate that product cost is one of the reasons for a decrease. 27. What member s projections are for physician employment. All of the respondents indicate that they foresee increases in all specialties of physician employment with family practice as the highest increase according to 95% of respondents. 28. If members achieved $100,000 in savings, how would their organization use the savings. 38% of the respondents indicate they will buy capital equipment if they could achieve such savings, while 32% will use such savings to renovate facilities. Member & Market Research 5 Summer 2012

8 DETAILED FINDINGS Top concerns that member facility faces in the current economic environment 1 Respondents indicate that the top concerns that their facilities face in the current economic environment are Reimbursement cuts, Impact on healthcare reform, and Reduced operating margins. Concerns that member facility faces in the current economic environment Rank Order Score Rank Reimbursement cuts Impact of Healthcare Reform Reduced operating margins Declining overall patient volumes Increased bad debt & charity care Ability to attract quality physicians Access to capital funding Value based purchasing Increased competition and accountability Nursing staff retention Fewer elective procedures Mergers, takeovers, or acquisitions Raw material price increases Other Rank Order Calculation is determined by using the following methodology: the number of respondents who rated a concern as #1 is multiplied by 14, the number of respondents who rated a concern as #2 is multiplied by 13, the number of respondents who rated a concern as #3 is multiplied by 12, etc. Everything is summed and the concern with the highest score is the top concern. Member & Market Research 6 Summer 2012

9 Other concerns mentioned: Margin is really covers all of these. Capital dollars to meet the investment requirements are significant. Decreased number and competition among healthcare supply and service vendors. Curtailed or having to eliminate services to the community. Government rules and regulation changes. Level of recovery from the economic downturn* 37% of the respondents indicate that they have significantly improved financially from the economic downturn. 22% indicate that there is no change in financial situation, while 42% indicate that the financial situation has worsened. (mean=2.8, n=65) 42% 22% 37% 0% 20% 40% 60% 80% 100% Financial situation has worsened (1-2) No change in financial situation (3) Significant financial improvement has occurred (4-5) *Percentages may total more than 100% due to rounding. Member & Market Research 7 Summer 2012

10 Whether member facilities foresee an increase, decrease, or no change in staffing over the next year because of the economic environment 12% of the respondents foresee an increase in staffing over the next year. 46% foresee a decrease, while 42% indicate that there is no change in staffing. n=66 Increase, 12% No change, 42% Decrease, 46% Member & Market Research 8 Summer 2012

11 Areas where member facilities expect a staff increase in their facilities A majority of respondents expect a staff increase in clinical (75%) and nursing (75%), followed by pharmacy (63%) and physicians (50%). n=8 Clinical (n=6) Nursing (n=6) 75% 75% Pharmacy (n=5) 63% Physicians (n=4) 50% Materials (n=1) Support services (n=1) Other (n=1) 13% 13% 13% 0% 20% 40% 60% 80% 100% * Percentages will not total 100% as respondents were able to choose more than one. Others: IT. Member & Market Research 9 Summer 2012

12 Areas where member facilities expect a staff decrease in their facilities 90% of the respondents expect a staff decrease in support services, 61% expect a staff decrease in clinical and 48% expect a staff decrease in nursing. n=31 Support Services (n=28) 90% Clinical (n=19) 61% Nursing (n=15) Materials (n=13) 42% 48% Capital (n=8) 26% Pharmacy (n=3) Physicians (n=1) Other (n=1) 10% 3% 3% 0% 20% 40% 60% 80% 100% * Percentages exceed 100% as respondents were able to choose more than one. Others: Office/clerical support/admin. Member & Market Research 10 Summer 2012

13 Whether member facilities foresee an increase, decrease, or no change in supply spending over the next year at their facilities 29% of the respondents indicate that they foresee an increase in supply spending over the next year at their facilities. 42% foresee a decrease, while 29% indicate that there is no change in supply spending. n=66 No change, 29% Increase, 29% Decrease, 42% Member & Market Research 11 Summer 2012

14 The percentage that member facilities anticipate an increase in supply spending within their facilities Of the 29% of the respondents who foresee an increase in supply spending over the next year at their facilities, 58% indicate that they anticipate an increase between 1 and 5 percent within their facilities. n= % (42%) 1-5% (58%) The percentage that member facilities anticipate a reduction in supply spending within their facilities Of the 42% of the respondents who foresee a decrease in supply spending over the next year at their facilities, 54% indicate that they anticipate a reduction between 6 and 10 percent within their facilities. n=28* >20% 4% 6-10% 54% 1-5% 43% *Percentages may not total 100% due to rounding. Member & Market Research 12 Summer 2012

15 Whether member facilities foresee an increase, decrease, or no change in their facilities improvement and capital projects over the next year 32% of the respondents foresee an increase in their facilities improvement and capital projects over the next year. 29% foresee a decrease, while 39% indicate that there is no change in their facilities improvement and capital projects. n=66 No change 39% Increase 32% Decrease 29% Please provide information on what areas or projects are being cancelled or delayed. Larger renovation projects in the older hospital plant building Non-critical items are delayed. We just remodeled, so no new projects are planned. Replacing equipment. Inpatient bed renovation. Capital equipment spending is being decreased. Finishing current construction project. Medical Office Building. Just completed the construction of a new hospital so will be operationalizing it this year. Grounds improvement. Expansion project of additional in-patient rooms delayed. All projects have been delayed or cancelled for an indefinite period of time. Member & Market Research 13 Summer 2012

16 The percentage that member facilities anticipate a reduction in capital spending Of the 29% who foresee a decrease in capital spending in their facilities over the next year, 64% anticipate a reduction between 0 and 10 percent in capital spending. n=17* >20% 29% 0-5% 29% 11-20% 6% 6-10% 35% *Percentages may not total 100% due to rounding. Member & Market Research 14 Summer 2012

17 The percentage that member facilities anticipate an increase in capital spending Of the 32% who foresee an increase in capital spending in their facilities over the next year, 35% indicate that they anticipate an increase between 0 and 5 percent in capital spending. Another 30% anticipate increases between 6 and 10 percent. n=20* >20% 20% 0-5% 35% 11-20% 15% 6-10% 30% *Percentages total more than 100% due to rounding. Areas member facilities plan on improving or capital projects their hospitals plans on starting during the next year: Expansion of infrastructure for core services. As well investment in new services lines. Infrastructures. Remodeling project (including a new ER). Remodeling patient rooms and updating public areas. X Ray equipment and IT. Facilities. Hospital Infrastructure, Outpatient Facility including Cancer Center. Trying to build/renovate our current facility. This is our peak spending for the next 20 years. Primary care nursing unit upgrades women s and children s cancer. New ER being built. Emergency Room, Imaging. Addition and renovation to move to private rooms. Facilities Member & Market Research 15 Summer 2012

18 What is your current capital budget? 61% of the respondents have a capital budget that is under $20M. 20% indicate that they have a capital budget that is $20-40M, while 7% have a capital budget of $40-80M. 13% of the respondents have a capital budget that is over $80M. n=46* $40-80M 7% Over $80M 13% $20-40M 20% Under $20M 61% *Percentages total more than 100% due to rounding. Member & Market Research 16 Summer 2012

19 Whether member facilities foresee an increase, decrease, or no change in surgical procedures over the next year at their facilities 43% of the respondents foresee an increase in surgical procedures over the next year at their facilities. 15% foresee a decrease while 42% indicate that there is no change in surgical procedures. n=65 No change, 42% Increase, 43% Decrease, 15% Member & Market Research 17 Summer 2012

20 Types of surgical procedures where member facilities expect an increase 68% of the respondents indicate that they expect an increase in knee (orthopedic) procedures, hip (orthopedic) procedures (61%), and back (orthopedic) procedures (50%). n=28 Knee (orthopedic) procedures (n=19) Hip (orthopedic) procedures (n=17) 61% 68% Back (orthopedic) procedures (n=14) Cardiac procedures (n=12) 43% 50% Bariatric procedures (n=9) 32% Elective plastic surgery (n=4) Reproductive surgeries (n=4) Hernia repair (n=4) 14% 14% 14% Other (n=10) 36% 0% 10% 20% 30% 40% 50% 60% 70% 80% * Percentages exceed 100% as respondents were able to choose more than one. Others: URO. Urology; GI. High Acuity cases. Oncology (all specialties). General surgery. General Scopes etc. Lap cholecysteomy General Member & Market Research 18 Summer 2012

21 Types of surgical procedures where member facilities expect a decrease 50% of the respondents indicate that they expect a decrease in knee (orthopedic) procedures and hip (orthopedic) procedures. n=10 Knee (orthopedic) procedures (n=5) Hip (orthopedic) procedures (n=5) 50% 50% Back (orthopedic) procedures (n=4) Elective plastic surgery (n=4) Cardiac procedures (n=4) 40% 40% 40% Bariatric procedures (n=2) 20% Hernia repair (n=1) Reproductive surgeries (n=1) 10% 10% Other (n=2) 20% 0% 10% 20% 30% 40% 50% 60% * Percentages exceed 100% as respondents were able to choose more than one. Others: General. Member & Market Research 19 Summer 2012

22 Do you foresee an increase, decrease, or no change in spending on purchased or outsourced services (e.g., Pharmacy management, Food services, Housekeeping, Clinical equipment maintenance, Nurse staffing, Temporary clinical/non-clinical staffing services, Transcription services) over the next year? 15% of the respondents foresee an increase in spending on purchased or outsourced services. 14% foresee a decrease while 71% indicate that there is no change in spending on purchased or outsourced services. n=65 Increase 15% No change 71% Decrease 14% Member & Market Research 20 Summer 2012

23 Areas where member facilities expect an increase in spending on purchased or outsourced services over the next year: Food services, housekeeping, laundry, biomed, print management, IT. Temporary clinical help. Transcription. Support services. Housekeeping transport therapy. Food Service, Environmental Services, Physician Revenue Cycle. New Surgery center. Lab, Pharmacy, Food Services, IT. Dietary, EVS. Areas where member facilities expect a decrease in spending on purchased or outsourced services over the next year: Maintenance Consultants. Outsourced management services. Management services in Food Services; Management services in Clinical Engineering; Transcription; Linen. We had a very negative conversion to outsourced food service that will probably limit or reverse outsourcing. Service Contracts of all types. Transcription, dietary, housekeeping, laboratory reference testing, ED physician staffing. Nursing Member & Market Research 21 Summer 2012

24 Whether member facilities expect their purchasing of new medical technology to increase, decrease, or no change over the next year 33% of the respondents expect their purchasing of new technology to increase over the next year. 16% expect a decrease, while 52% indicate that there is no change. n=64* No change, 52% Increase, 33% Decrease, 16% *Percentages total more than 100% due to rounding. Member & Market Research 22 Summer 2012

25 What processes do you employ to determine which new technologies are purchased for use in your facilities? We have a business planning and development committee, a product acquisition committee, a scored capital budgeting process, service line oversight committees. Value assessment committee, capital evaluation process. Value Analysis; ROI. Value Analysis, Capital Equipment Committees. Value analysis in combination with capital and financial review. Technology Committee, Value Analysis Committee, Physician Advisory Committee. Senior staff prioritizing with allocated capital budget. Review of financial and clinical information. Review by senior management of significant technologies before purchased. Research ROI Planning. Replacement purchases or new service lines. Product review teams, most effective in our surgical area. Part of the capital budgeting process. Medical staff input, market/competitor services available. Medical & Surgical Value Analysis. Market surveys, community need. Market growth with ROI. Equipment required to interface to EMR. If it increases volume or provide a new or increased revenue stream, it will be approved. HER. ECRI; Surgeon onboarding. ECRI. Each project is headed by the department head proposing the new purchase, working with CFO and including IT as necessary. Doctor interest. Current projects that take years to complete. Capital budget committee vets new technology. Competition, Physician Input. Committee review. Committee. Capital request review. How much can we afford to purchase. Capital Committee review. Member & Market Research 23 Summer 2012

26 Whether member facilities foresee an increase, decrease, or no change in the purchase of IT infrastructure over the next year at their facilities 58% of the respondents foresee an increase in IT infrastructure purchase over the next year at their facilities. 10% foresee a decrease, while 32% indicate that there is no change IT infrastructure purchase over the next year. n=62 No change, 32% Increase, 58% Decrease, 10% Member & Market Research 24 Summer 2012

27 What processes do you employ to determine which new technologies are purchased for use in your facilities? Value Analysis, Capital Equipment Committees. User Committee approval, senior staff approval, Board approval. System wide IT evaluation. Review by I.T. and senior management. Replacement schedules and HIPAA and HITECH compliance and CPOE. Physician driven; cost analysis of cost vs. reimbursement. Obsoleting of current products with no support. Projects that are in continuation over several years. Need to move away from paper to integrated record. Market pressure. Quality indications. It's been at a high level as we've gone to EMR and will stay the same until we level 8, currently level 6 and moving beyond. IT resources based on deployment of clinical need. IT infrastructure has been updated with implementation of EMR. IT Committee. Infrastructure assessments and capital budgeting process. Information technology oversight committee. Government regulations. EMR. Currently in the middle of a major systems conversion to Epic. Committee and department recommendations with Board approval. CIO determines. Bidding. All new last year. Member & Market Research 25 Summer 2012

28 Whether member facilities foresee an increase, decrease, or no change in pharmacy spending over the next year at their facilities 41% of the respondents foresee an increase in pharmacy spending over the next year at their facilities. 16% foresee a decrease, while 44% indicate that there is no change in pharmacy spending over the next year. n=64* No change, 44% Increase, 41% Decrease, 16% *Percentages total more than 100% due to rounding. Member & Market Research 26 Summer 2012

29 The factor(s) that are driving the increase in pharmacy spending over the next year 73% of the respondents identify drug shortages as driving the increase in pharmacy spending over the next year. Another 69% indicate that Oncology-branded products drive the increase in pharmacy spending. n=26 Drug shortages (n=19) 73% Oncology-branded products (n=18) 69% Increased volume (n=10) 38% New biologics-branded products (n=8) 31% Other (n=4) 15% 0% 10% 20% 30% 40% 50% 60% 70% 80% * Percentages exceed 100% as respondents were able to choose more than one. Others: Vendor Price Increases. Overutilization of drugs for Psych & Geriatric populations. In-house pharmacy program. Increased reliance on Pharma. Member & Market Research 27 Summer 2012

30 Areas where member facilities are focusing their efforts to reduce costs 80% of the respondents indicate that they are focusing their efforts to reduce costs by standardization. Other areas where respondents are focusing their efforts to reduce costs are process improvement (77%), commitment to GPO (69%), renegotiating with vendors (64%), and utilization (61%). n=64 Standardization (n=51) Process improvement (n=49) Commitment to GPO (n=44) Renegotiating with vendors (n=41) Utilization (n=39) 80% 77% 69% 64% 61% Reducing of staff (n=22) Commitment to single source contracts (n=21) Consolidating services (n=20) 34% 33% 31% Other (n=7) 11% 0% 20% 40% 60% 80% 100% * Percentages exceed 100% as respondents were able to choose more than one. Others: Regional Collaborations. Lower par levels. MSS Commitment. Service Contracts. 340B. Outsourcing. Westpac purchasing coalition. Member & Market Research 28 Summer 2012

31 Whether member facilities foresee an increase, decrease, or no change in spending on spinal products over the next year 20% of the respondents indicate that they foresee an increase in spending on spinal products over the next year. 19% foresee a decrease, while 61% indicate that there is no change in spending on spinal products. n=64 Increase, 20% No change, 61% Decrease, 19% Member & Market Research 29 Summer 2012

32 Why member facilities indicated that there would be a/an increase/decrease/no change in spending on spinal procedures over the next year 100% identified aging population as one of the reasons why there would be an increase in spending on spinal procedures. 50% identified product cost as one of the reasons for a decrease. Aging population 100% Procedure growth/decline 8% 42% 50% Product cost 17% 33% 50% Other 13% 22% 66% * Percentages exceed 100% as respondents were able to choose more than one. Increase, others: Added a surgeon. New surgeons. New service line we are adding. New physician. Decrease, others: Standardization. Reduction of vendors. Negotiation. Renegotiated pricing. Standardization. New Agreements. Renegotiate contracts. 0% 20% 40% 60% 80% 100% 120% Increase Decrease No change Member & Market Research 30 Summer 2012

33 No change, others: Little to no volume of surgery in this area. Smaller market offset aging population. Don't do any spinal procedures. We do not do Spinal Surgery. No spinal surgeon. We don't do them. No program in place. Do not do spine. Don t currently offer. Don't do. Do not do these. Set number of Physicians on Medical Staff doing these procedures. We don't do spine. No factors to indicate any change. Don't offer it. Do not have a spine program. Lost Neuro Surgeon. No spinal procedures. Not done in this facility. We do not offer this procedure. We don't do spinal procedures. Member & Market Research 31 Summer 2012

34 Whether member facilities foresee an increase, decrease, or no change in spending on orthopedics products over the next year 39% of the respondents indicate that they foresee an increase in spending on orthopedics products over the next year. 28% foresee a decrease, while 33% indicate that there is no change in spending on orthopedics products. n=64 No change, 33% Increase, 39% Decrease, 28% Member & Market Research 32 Summer 2012

35 Why member facilities indicated that there would be a/an increase/decrease/no change in spending on orthopedics products over the next year 85% identified aging population as one of the reasons why there would be an increase in spending on orthopedics products. 53% of respondents identified product cost as one of the reasons for a decrease. Aging population 15% 85% Procedure growth/decline 14% 28% 59% Product cost 16% 32% 53% Other 29% 33% 38% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Increase Decrease No change * Percentages exceed 100% as respondents were able to choose more than one. Increase, others: Added surgeons. More ortho surgeons. Additional Physicians. New Physician. 2 new orthopods. Adding volume with new hospital. New physician practice opening. Member & Market Research 33 Summer 2012

36 Decrease, others: Renegotiate contracts. Transfer of Hip/Knees to sister hospital. Negotiation. Renegotiated pricing. Standardization. New Agreements. Renegotiate contracts. No change, others: Still short a surgeon. Local clinic. Established contracts. Smaller market offsets aging population. Competition. No reason to expect any change. No orthopedic products. We don't do ortho procedures. No Orthopod. Member & Market Research 34 Summer 2012

37 Whether member facilities foresee an increase, decrease, or no change in spending on cardiology products over the next year 33% of the respondents indicate that they foresee an increase in spending on cardiology products over the next year. 22% foresee a decrease, while 45% indicate that there is no change in spending on cardiology products. n=64 No change, 45% Increase, 33% Decrease, 22% Member & Market Research 35 Summer 2012

38 Why member facilities indicated that there would be a/an increase/decrease/no change in spending on cardiology products over the next year* 68% identify the procedure growth as one of the reasons why there would be an increase in spending on cardiology products. 37% indicate that product cost is one of the reasons for a decrease. Procedure growth/decline 16% 16% 68% Product cost 32% 32% 37% Other 19% 19% 63% 0% 10% 20% 30% 40% 50% 60% 70% 80% Increase Decrease No change * Percentages exceed 100% as respondents were able to choose more than one. Increase, others: New cardiac rehab unit. New surgeon. Adding peripheral vascular intervention. New EP Lab. Adding volume with new hospital. Decrease, others: Negotiation. Better pricing. Standardization. New contract with lower pricing. Loss of cardio surgeon. Member & Market Research 36 Summer 2012

39 No change, others: Renegotiating with CSC. Don t have much call for it. Only in the ER. Volumes have stagnated. Don't do cardio. MSS Contracts. Do not do these. Don t provide services. Smaller market offsets aging population. Competitive market. No major cardiology services. No cardiologist. No program. We do not offer this procedure. Don t do cardio. Do not do cardiology. Do not do cardiology procedures. We do not do cardiology procedures. What are your projections for physician employment, by specialty? All of the respondents indicate that they foresee increases in all specialties of physician employment with family practice as the highest increase according to 95% of respondents. Physician employment* Increase Decrease n Orthopedics 80% 21% 39 Cardiologist 88% 13% 32 Internal Medicine 81% 19% 36 Anesthesiology 73% 27% 22 Gastroenterologist 71% 29% 24 Radiologist 74% 26% 19 Oncologist 79% 21% 29 Family practice 95% 5% 43 Other (please specify): 100% -- 4 *Percentages may total more than 100% due to rounding. Member & Market Research 37 Summer 2012

40 Other (please specify): We don't employ any physicians. We do not employ any specialty physicians. We are in need of a new family practitioner. Urology. Primary Care. Physical Medicine. ENT. Endocrinologist If you achieved $100,000 in savings, how would your organization use the savings? * 38% of the respondents indicate they will buy capital equipment if they could achieve such savings, while 32% will use such savings to renovate facilities. n=53 Buy capital equipment (n=25) 38% Renovate facilities (n=21) 32% Patient outcomes (n=16) 24% IT infrastructure (n=15) 23% Staff new services (n=13) 20% Other (n=14) 21% 0% 10% 20% 30% 40% * Percentages exceed 100% as respondents were able to choose more than one. Member & Market Research 38 Summer 2012

41 LIMITATIONS VHA ORGANIZATIONS To reduce the survey load without affecting statistical validity, Member & Market Research employs a sampling methodology in the VHA population. The sampling methodology is a stratified systematic sample, with two strata geographic region and bed-size within region. Every 3rd facility is selected in this sampling frame, and a new set of samples is drawn every year. Sample groups are rotated between surveys, so that any one VHA organization should receive a survey every third time. When multiple audiences are surveyed a unique sample is used for each audience. The sample sizes are large enough to provide feedback from a group that is representative of the VHA population. UHC ORGANIZATIONS Due to the small population size of the UHC membership all organizations are surveyed. Because this is not a probability sample, some caution may be necessary when projecting these results to the UHC population since the responses may not be representative. The report contains the actual number of responses and the associated percentages, based on respondent input. RANDOM ERROR (OR VARIABLE ERROR) The variable errors attributed to sampling. These errors occur when a probability sampling method is used to select a sample and the sample respondents may not representative of the population. SYSTEMATIC ERROR (OR BIAS ERROR) Nonsampling errors associated with a research project. Types of nonsampling errors are instrument, investigator, respondent, processing, non-response and non-coverage. Non-response error deals with the failure to obtain information from some respondents who were selected to be in the sample. There are two sources of non-response error: Non-contact, which is the inability to reach the respondent and Refusal, where the respondent declines to participate. Non-response error can be significant if respondents and non-respondents have different views and opinions. Member & Market Research 39 Summer 2012

42 MARKET RESEARCH DEFINITIONS n The number of respondents who answered a particular question Mean/Average Value The sum of the values of all observations divided by the number of observations. It is also called the arithmetic average. Median Value The value above which and below which half of the cases fall, the 50th percentile. For example, if there are 5 cases, the median is the third largest (or smallest) observation. When there is an even number of observations, the median is the average of the 2 middle observations. Member & Market Research 40 Summer 2012

43 Questionnaire 1. Please identify your top 5 concerns that your facility faces in the current economic environment. Force Rank [ ] Ability to attract quality physicians [ ] Access to capital funding [ ] Declining overall patient volumes [ ] Fewer elective procedures [ ] Impact of Healthcare Reform [ ] Increased bad debt & charity care [ ] Increased competition and accountability [ ] Mergers, takeovers, or acquisitions by or of other facilities [ ] Nursing staff retention [ ] Raw material price increases [ ] Reduced operating margins [ ] Reimbursement cuts [ ] Value based purchasing [ ] Other (please specify): 2. Please rate your current financial condition compared to the beginning of the downturn in Current financial condition vs 2008 Financial situation has worsened 1 2 No change in financial situation 3 4 Significant financial improved has occurred 5 3. Because of the economic environment of the past several years, do you foresee an increase, decrease, or no change in staffing over the next year at your facility? [ ] Increase Go to question 3a [ ] Decrease Go to question 3b [ ] No change 3a. Please identify those areas where you expect a staff increase in your facility. (Check all that apply). [ ] Capital [ ] Clinical [ ] Materials Member & Market Research 41 Summer 2012

44 [ ] Nursing [ ] Pharmacy [ ] Physicians [ ] Support Services [ ] Other (please specify): 3b. Please identify those areas where you expect staff decrease in your facility. (Check all that apply) [ ] Capital [ ] Clinical [ ] Materials [ ] Nursing [ ] Pharmacy [ ] Physicians [ ] Support Services [ ] Other (please specify): 4. Do you foresee an increase, decrease, or no change in supply spending over the next year at your facility? [ ] Increase Go to question 4a [ ] Decrease Go to question 4b [ ] No change 4a. By what percentage do you anticipate an increase in supply spending within your facility? [ ] 1-5% [ ] 6% - 10% [ ] 11% - 20% [ ] > 20% 4b. By what percentage do you anticipate a reduction in supply spending within your facility? [ ] 1-5% [ ] 6% - 10% [ ] 11% - 20% [ ] > 20% 5. Do you foresee an increase, decrease, or no change in your facilities improvement, construction, and capital projects over the next year? [ ] Increase Go to question 5c [ ] Decrease Go to question 5a [ ] No change Go to question 5e 5a. Please provide information on what areas or projects are being cancelled or delayed. Member & Market Research 42 Summer 2012

45 5b. By what percentage do you anticipate your reduction in capital spending? (skip to 5e) [ ] 0% 5% [ ] 6% - 10% [ ] 11% - 20% [ ] > 20% 5c. By what percentage do you anticipate an increase in capital spending? [ ] 0% 5% [ ] 6% - 10% [ ] 11% - 20% [ ] > 20% 5d. Please identify what areas you plan on improving or capital projects your hospital plans on starting during the next year. 5e. What is your current capital budget? [ ]Under $20M [ ]$20-40M [ ]$40-80M [ ]Over $80M 6. Do you foresee an increase, decrease, or no change in surgical procedures over the next year at your facility? [ ] Increase Go to question 6a [ ] Decrease Go to question 6b [ ] No change 6a. Please identify the types of surgical procedures where you expect an increase. (Check all that apply) (Sort alphabetically or randomize) [ ] Back (Orthopedic) Procedures [ ] Bariatric Procedures [ ] Cardiac Procedures [ ] Elective Plastic Surgery [ ] Hernia Repair [ ] Hip (Orthopedic) Procedures [ ] Knee (Orthopedic) Procedures [ ] Reproductive Surgeries [ ] Other (please specify): 6b. Please identify the types of surgical procedures where you expect a decrease. (Check all that apply) (Sort alphabetically) Member & Market Research 43 Summer 2012

46 [ ] Back (Orthopedic) Procedures [ ] Bariatric Procedures [ ] Cardiac Procedures [ ] Elective Plastic Surgery [ ] Hernia Repair [ ] Hip (Orthopedic) Procedures [ ] Knee (Orthopedic) Procedures [ ] Reproductive Surgeries [ ] Other (please specify): 7. Do you foresee an increase, decrease, or no change in spending on purchased or outsourced services (e.g., Pharmacy management, Food services, Housekeeping, Clinical equipment maintenance, Nurse staffing, Temporary clinical/non-clinical staffing services, Transcription services) over the next year? [ ] Increase Go to question 7a [ ] Decrease Go to question 7b [ ] No change 7a. Please identify the areas where you expect an increase in spending on purchased or outsourced services over the next year. 7b. Please identify the areas where you expect a decrease in spending on purchased or outsourced services over the next year 8. Do you expect your purchasing of new medical technology to increase, decrease, or not change over the next year? [ ] Increase Go to question 8a [ ] Decrease Go to question 8a [ ] Not change Go to question 8a 8a. What processes do you employ to determine which new technologies are purchased for use in your facilities? 9. Do you expect your purchasing of IT infrastructure to increase, decrease or not change over the next year? [ ] Increase Go to question 10 [ ] Decrease Go to question 10 [ ] Not change Go to question 10 Member & Market Research 44 Summer 2012

47 10. Do you foresee an increase, decrease, or no change in pharmacy spending over the next year at your facility? [ ] Increase Go to 10a [ ] Decrease Go to 11 [ ] No change Go to 11 10a. Please identify the factor(s) that are driving the increase in pharmacy spending over the next year. [ ] Drug shortages [ ] Increased volume [ ] Increased prices on existing drugs [ ] New biologics- branded products [ ] Oncology-branded products [ ] Other (please specify): 11. Please identify where your facility is focusing its efforts to reduce costs. [ ] Commitment to GPO [ ] Commitment to single source contracts [ ] Consolidating services [ ] Reduction of staff [ ] Renegotiating with vendors [ ] Standardization [ ] Utilization [ ] Process improvement [ ] Other (please specify): 12a. Do you foresee an increase, decrease, or no change in spending on Spinal products over the next year? [ ] Increase [ ] Decrease [ ] No change 12a1. Please indicate why you indicated that there would be a/an [insert answer from 12a] in spending on Spinal products over the next year. [ ] Aging population [ ] Procedure growth/decline [ ] Product cost [ ] Other (please specify): Member & Market Research 45 Summer 2012

48 12b. Do you foresee an increase, decrease, or no change in spending on Orthopedics products over the next year? [ ] Increase [ ] Decrease [ ] No change 12b1. Please indicate why you indicated that there would be a/an [insert answer from 12b] in spending on Orthopedics products over the next year. [ ] Aging population [ ] Procedure growth/decline [ ] Product cost [ ] Other (please specify): 12c. Do you foresee an increase, decrease, or no change in spending on Cardiology products over the next year? [ ] Increase [ ] Decrease [ ] No change 12c1. Please indicate why you indicated that there would be a/an [insert answer from 12c] in spending on Cardiology products over the next year. [ ] Procedure growth/decline [ ] Product cost [ ] Other (please specify): 13. What are your projections for physician employment, by specialty? Increase Orthopedics Cardiologist Internal Medicine Anesthesiology Gastroenterologist Radiologist Oncologist Family practice Other (please specify): Decrease 14. Do you have suggestions on how Novation can assist your facility through these challenging times? Please provide your input below. 15. If you achieved $100,000 in savings, how would your organization use the savings?(check all that apply) Member & Market Research 46 Summer 2012

49 [ ] Renovate facilities [ ] Buy capital equipment [ ] Staff new services [ ] Patient outcomes [ ] IT infrastructure [ ] Other (please specify): 16. May someone from Novation follow up with you regarding your responses? [ ] Yes (Go to question 16a) [ ] No (End of survey) 16a. If yes, please provide your contact information below. Name: Organization: Title: Phone number: address: Thank you for completing the survey! Member & Market Research 47 Summer 2012

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