Michigan Heart & Vascular Institute ON THE ST. JOSEPH MERCY HOSPITAL CAMPUS, ANN ARBOR, MICHIGAN

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2 ON THE ST. JOSEPH MERCY HOSPITAL CAMPUS, ANN ARBOR, MICHIGAN Dear Colleague: Cardiovascular medicine has marked an important milestone in the battle against heart disease. The latest available data indicates heart disease is no longer the number one cause of death for people under 85. We at the celebrate this achievement but know there is a lot more work to do. I am proud to be a member of the remarkable cardiovascular team at SJMHS and the (MHVI). MHVI is among the largest cardiovascular disease centers in Michigan, as well as an accredited and recognized leader in cardiovascular medicine and surgery. SJMHS and MHVI are achieving award-winning clinical outcomes that reflect our commitment to excellence. I urge you to review this brochure. You will discover that our team has the knowledge, the latest technology and therapies, as well as the compassion, to support the treatment of your patients with risk for cardiovascular diseases. In addition, SJMHS and MHVI have the capacity and expert personnel to accommodate your referrals at any time. We are leaders in four critical areas of cardiovascular treatment: 1. Volume of procedures: with experience comes expertise 2. Quality clinical outcomes and commitment to their measurement 3. Breadth of capabilities: including advanced technology, subspecialized expertise and clinical research 4. Electronic health record and disease management We are committed to maintaining strong professional relationships and collaborating with physicians like you to continuously improve our practice and to insist on evidencebased therapies in the fight against cardiovascular disease. Sincerely, Stuart A. Winston, D.O., FACC Medical Director, MHVI St. Joseph Mercy Hospital, Ann Arbor, Michigan Since the 1950 s, MHVI has set the pace for excellence and innovation in cardiovascular medicine and surgery. The Institute, a cornerstone of the Saint Joseph Mercy Health System (SJMHS), has become a nationally-respected leader as a comprehensive center for diagnostic testing, medical treatment and surgical intervention. MHVI has accrued the most advanced technologies and is actively engaged in clinical research to help access the latest and most effective treatments. MHVI has a team of more than 45 board-certified cardiovascular specialists, recruited from the leading U.S. programs: Cardiologists Interventional radiologists Cardiothoracic surgeons Vascular surgeons MHVI physicians collaborate with a dedicated support staff, including physician assistants, nurses, nutritionists, technologists, social workers, and exercise physiologists. MHVI is Michigan s third largest cardiovascular disease center: Diagnostic catheterizations 3,600 Percutaneous cardiac interventions 1,500 Therapeutic procedures for arrhythmia 1,800 Coronary artery bypass and valve surgeries 800 Vascular surgery procedures 1,200 Vascular diagnostic lab procedures 18,500 Non-invasive diagnostic cardiac studies 36,530 MHVI achieves quality outcomes with minimal complications and mortality: Acute myocardial infarction: MHVI exceeds state and national averages for AMI CORE Measure Rates (1200 cases treated annually) Heart failure: MHVI exceeds state and national averages for HF CORE Measure Rates (900 cases treated annually) Pertucaneous cardiac interventions: High success and low morbidity (1.05% mortality compared to the risk-adjusted predicted 1.43%) Cardiothoracic surgery: Low morbidity and mortality (2.30% mortality compared to the risk adjusted predicted 2.89%) Carotid Endarterectomy: Mortality and complication rate below national averages. MHVI delivers complex, effective care for the full range of cardiovascular modalities, and is also committed to the prevention of cardiovascular disease by providing extensive community and patient programs with education, rehabilitation and support groups Volume Data 2

3 Cardiology Overview MHVI has assembled a team of respected experts in cardiology to create a remarkable synergy of subspecialties rarely found in a single location. Our expertise includes: Arrhythmia management Echocardiography Cardiac CT and MR Coronary intervention Congenital heart disease Cardiac electrophysiology Peripheral vascular intervention Nuclear cardiology Heart failure Disease prevention Lipid management Valve disease Our Cardiac Diagnostic Labs are accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories. The Chest Pain Center at St. Joseph Mercy Hospital is accredited by the Society of Chest Pain Centers. MHVI is designated as a Cardiology Center of Excellence by Blue Cross Blue Shield of Michigan (BCBSM). Same Day & Next Day Appointments MHVI cardiologists are committed to responsive service and accommodating your urgent requests for consultation within 24 hours. Inpatient Volume Annually, MHVI cares for approximately 1200 patients with acute myocardial infarctions (AMI) and 900 with Heart Failure (HF). MHVI has been a leader in quality care measurement for AMI and HF patients. The quality of care is reflected in the AMI & HF CORE Measure rates that are publicly reported quarterly to the Center for Medicare & Medicaid Services and the Joint Commission on Accreditation of Healthcare Organization (JCAHO). MHVI exceeds state and national averages for these CORE Measure Rates. Acute Myocardial Infarctions CORE Measure Rates C a r d i o l o g y Cardiology Services Computed tomography (CT) of the heart Magnetic resonance imaging (MRI) of the heart Nuclear cardiology, including exercise and pharmacological imaged stress testing Surface and transesophageal echocardiology (including contrast and digital echo) Lipid Management Program Heart of a Woman Program Multiple modality valve disease diagnosis and treatment Advanced heart failure management including echo guided Cardiac Resynchronization Therapy and Heart Failure Clinic Specialized diagnostic evaluation with syncope patients Comprehensive arrhythmia diagnosis and advanced treatment including advanced ablative therapies and an atrial fibrillation clinic Dedicated device and arrhythmia follow-up clinic Peripheral Vascular Disease assessment and treatment Cardiac and vascular rehabilitation ACEI at Discharge Beta Blocker at Discharge PCI within 120 Minutes 92.2% 86% 99% 95% 72.1% 65% SJMH 12 month Average Michigan Mean Heart Failure CORE Measure Rates Discharge Instructions LVF Assessment ACEI at Discharge 76% 60% SJMH 12 month Average 98% 87% 85.6% 85% Michigan Mean 5

4 Interventional Procedures Overview SJMHS state-of-the-art Imaging Center and its expanding capabilities in cardiac and vascular imaging help provide extraordinary cardiovascular diagnostic and interventional care. I n t e r v e n t i o n a l P R O C E D U R E S MHVI leverages the most innovative technology to achieve a minimally invasive approach to interventional cardiology and vascular medicine. Referring physicians and their patients benefit from our commitment to imaging excellence: MHVI was the first in southeastern Michigan to offer the digital Philips Flat Detector for the highest resolution in cardiac and vascular imaging in health care today. Dedicated cardiac MRI protocols and multi-slice cardiac CT enhances the understanding of cardiac disease and its early detection. Leading-edge technology yields more accurate and detailed information for making complex clinical decisions. Outcomes of Interventional Procedures Quality outcomes are monitored through participation in the Blue Cross and Blue Shield of Michigan Cardiovascular Consortium. Cardiologists perform a comprehensive spectrum of diagnostic and interventional procedures - more than 5,000 annually: 3,600 Diagnostic Catheterizations 1,500 Percutaneous cardiac interventions.09% mortality rate 1.2% complication rate 1.43% predicted mortality 1.05% SJMH mortality ELECTROPHSIOLOGY PROCEDURES MHVI s electrophysiology team performs 3,100 electrophysiology procedures annually. MHVI is a leading center for bi-ventricular devices for heart failure. Interventional Procedures Services Diagnostic heart catheterization Cardiac interventions, including: - Drug eluting stents - Atherectomy - Rotoblator - Percutaneous valvuloplasty - PFO/ASD closures - Percutaneous ablation for hypertrophic obstructive cardiomyopathy Radial artery catheterizations Primary angioplasty for MI with surgical back-up 24/7 Diagnostic and interventional electrophysiology, including: - Radiofrequency ablation - Implantable cardioverter defibrillators - Cardiac resynchronization therapy - Pacemakers - Cardioversion - Tilt Table testing Catheter ablations, including pulmonary vein isolation of atrial fibrillation 220 Measure Rates Cardioversions 450 Implantable cardiac defibrillators (ICD s) 245 Tilt table test 240 Permanent pacemakers 350 7

5 Cardiothoracic Surgery Overview At MHVI, cardiothoracic surgeons achieve remarkable results while successfully performing virtually every cardiothoracic procedure: Valve repair and replacement Complete arterial coronary revascularization Aortic aneurysm repair Minimally invasive surgical treatments Beating Heart Surgery MHVI 2005 Volume of Cardiothoracic Surgeries by Procedure (Total of 1100 Cases per Year) Coronary Artery Bypass Grafting (CABG) 51% Lung Surgery 16% Valve Surgery 5% Aortic reconstruction 1% Other 27% Quality outcomes are monitored through participation in the National Society of Thoracic Surgeons (STS) database and the Michigan Society of Thoracic and Cardiovascular Surgeons/Blue Cross Blue Shield of Michigan Consortium. MHVI performs a high volume of cardiothoracic surgeries while maintaining high quality outcomes. Outcomes of Cardiothoracic Surgical Procedures Internal Mammary Artery Use 94% 91.8% Infection (deep sternal) 0.5% 0.5% Stroke 1.9% 1.4% O/E Mortality Rate 0.79% 0.78% Perfusion Time (minutes) Clamp Time (minutes) Reop for bleeding 1.6% 2.5% 2005 MHVI 2005 STS National C a r d i o t h o r a c i c S u r g e r y Cardiothoracic Surgery Services Coronary revascularization - Total arterial revascularization (mammary, radial) - Beating heart surgery - Minimally invasive coronary surgery - Redo coronary bypass surgery - Endoscopic venous and radial artery harvesting Valve surgery, including: - Valve repair and replacement (aortic, mitral, pulmonary, tricuspid) - Ross procedure - Stentless valve grafts - Human homograft Thoracic surgery - Multidisciplinary lung cancer specialty clinic - Minimally invasive lung surgery Heart Failure surgery Arrhythmia surgery (including Maze procedure for atrial fibrillation) Transmyocardial laser revascularization We are leaders in the country having performed over 3000 endoscopic vein harvesting procedures and are consultants for industry in developing this new technology. 9

6 Vascular Medicine & Surgery Overview From diagnosis to rehabilitation, MHVI vascular surgeons, interventional radiologists and cardiologists provide the most appropriate and expert care for peripheral vascular disease. V a s c u l a r M E d i c i n e & S u r g e r y The institute operates one of Michigan s largest and most recognized outpatient vascular laboratories in the country. Our team performs complex and specialized vascular surgeries and percutaneous interventions at St. Joseph Mercy Hospital, Ann Arbor. In addition, MHVI is pioneering one of the first U.S. programs to offer rehabilitation to patients with peripheral vascular disease. Annually, there are 1,200 vascular surgical procedures within MHVI, including: Carotid endarterectromy Surgical and percutaneous interventions Lower extremity revascularization Abdominal revascularization Aortic reconstruction and aortic stent-grafts Venous surgery Thoracic outlet syndrome Our Vascular Diagnostic Lab is accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL). The Vascular Diagnostic Lab completes approximately 18,500 procedures each year: Cerebrovascular Studies 3,712 Venous Studies 8,137 Arterial Studies 2,975 Abdominal Studies 1,350 Rehabilitation MHVI is pioneering one of the first U.S. programs to offer rehabilitation to patients with peripheral vascular disease. MHVI Cardiac and Vascular Rehabilitation Center supports patients efforts to: Improve walking Modify lifestyle and other risk factors Adjust daily living activities 2005 Volumes Vascular Medicine & Surgery Services Diagnostic and interventional peripheral vascular procedures, including: - Magnetic resonance angiography and CT angiography - Comprehensive peripheral percutaneous angioplasty and stenting - Carotid artery stenting - Atherectomy - Cryoplasty - Subintimal recanalization - Complex elective and emergent embolectomy Carotid endarterectomy Lower extremity surgical and percutaneous revascularization Abdominal revascularization surgery, including: - Visceral reconstruction (mesentric, renal) Aortic reconstruction, including: - Aneurysms (infrarenal, suprarenal, and thoracoabdominal) - Aortic stent grafting - Occlusive disease Temporary & permanent IVC filters Venous surgery including varicose vein restoration Pharamacomechanical thrombolysis of ileofemoral venous thrombosis Radiofrequency and laser ablation of varicose veins Non-invasive vascular studies, including: - Extremity Doppler - Carotid duplex - Abdominal duplex (celiac, superior mesentery artery, renal, aortic) - Venous duplex and reflux Vascular Rehabilitation 11

7 P a t i e n t S a t i s f a c t i o n & C l i n i c a l T r i a l s Patient Satisfaction & Clinical Trials Exceeding Expectations Two excellent measures of quality are: How patients perceive the quality of care The opinions of referring physicians like you Patient Satisfaction SJMHS cardiovascular units consistently scored exceptionally high marks in a 2005 patient satisfaction survey SJMHS Patient Satisfaction Survey MHVI is a leader in cardiac care 97% MHVI provides the highest quality care 97% Overall, I am impressed with MHVI 97% Referring Physician Satisfaction MHVI is exceeding expectations of referring physicians. In 2005, MHVI cardiologists conducted a survey of referring primary care physicians to measure their satisfaction with the quality of communications and services provided by MHVI cardiologists and surgeons. Their feedback was very positive MHVI Referring Physician Satisfaction Survey MHVI is a leader in cardiac care 100% MHVI provides the highest quality care 100% Overall, I am impressed with MHVI 96% I m satisfied with patient care at MHVI 96% 100% max. 100% max. Our Philosophy: A Collaborative, Multidisciplinary Approach MHVI cardiovascular treatment plans are developed through a multidisciplinary approach and shared expertise, including the input of the referring physician. Depending on the patient s needs, sub-specialists discuss the case and develop an individualized cardiovascular treatment plan. Then, one cardiovascular specialist coordinates the patient s care with his or her primary care physician. This strategy eliminates the practice of passing patients from one specialist to the next. MHVI achieves the optimal quality care experience by emphasizing collaboration. Leadership in Clinical Trials & Research High volume and a reputation for visionary leadership in cardiovascular medicine allows MHVI to participate in many cutting-edge research studies. Because of our commitment to research, cardiac patients have access to the latest therapies and clinical knowledge. Our Institute has a proven track record in clinical studies and its specialists are respected for their research experience. MHVI provides patients the opportunity to participate in a number of select clinical trials. In 2005, the institute had ongoing studies in these specialty areas: Interventional cardiology Acute coronary syndrome Heart failure Diabetes & CAD Carotid artery stenting Electrophysiology Valve surgery Clinical trials and testing the latest therapies and technology are essential to achieving our primary objectives: The prevention of cardiovascular diseases Ensuring optimal quality of care for individuals with those diseases For detailed information about our current clinical trials, please visit 13

8 Q u a l i t y & A c c o m p l i s h m e n t s Quality & Accomplishments Focused on Improvement At MHVI, the quality of patient care is paramount. We have developed collaborative multidisciplinary teams that routinely review and respond to data to identify opportunities for improvement. Based on that analysis, we make changes to further improve processes of care delivery. MHVI benchmarks outcomes against other leading programs in the U.S. This enables us to explore ways to improve our clinical services and develop best practices. To maintain the superior quality of our programs and services, we voluntarily submit data that is used for quality improvement and for reporting to regulatory agencies. These include: Blue Cross Blue Shield of Michigan Cardiovascular Consortium Society of Thoracic Surgeons National Registry Global Registry for Acute Coronary Syndrome Joint Commission on Accreditation of Healthcare Core Measures Centers for Medicare & Medicaid Services St. Joseph Mercy Hospital Quality Institute Trinity Health National Research Corporation Patient Satisfaction The data reflects the high standard of quality our patients can expect. We continue to update this data and make it available on our Web site: For your convenience, we ve provided a handy tear off reference card at the back of this brochure called: Leadership in Cardiovascular Medicine What Makes Us Remarkable? It highlights our leadership in volume, high-quality outcomes and other important benefits of referring patients to MHVI. The card also provides locations and phone numbers for each specialty. We encourage you to share this information with your patients. Accredited & Recognized MHVI is frequently recognized and honored as one of Michigan s premier cardiovascular treatment centers. Here are just a few of our most recent awards: Blue Cross Blue Shield of Michigan Cardiac Centers of Excellence Recognizing the quality of care provided by MHVI, Blue Cross Blue Shield of Michigan awarded St. Joseph Mercy Hospital, Ann Arbor the BCBSM Cardiac Centers of Excellence designation. The award is based on the volume of services provided by MHVI and its physicians, the high quality of outcomes and low mortality. Solucient 100 Top Hospitals: Cardiovascular This award objectivity measures performance on key criteria at the nation s top performing acute-care hospitals Accredited Chest Pain Center In January 2005, the Society of Chest Pain Centers granted St. Joseph Mercy Hospital the designation of Accredited Chest Pain Center. This is only the third such designation in the state and the 79th in the nation. This designation recognizes the high quality and efficient care provided by the Emergency Medicine and Cardiology physicians at St. Joseph Mercy Hospital. Hour Detroit Magazine Top Doc and Best Hospitals list Hour Magazine surveys health care professionals about: Their opinions of the best physicians Which hospitals they would choose for treatment for a loved one Over the last three years, survey participants named many of our MHVI physicians. They also named St. Joseph Mercy Hospital, Ann Arbor, as A Best Hospital for treatment of heart attacks. 15

9 (MHVI) On the St. Joseph Mercy Hospital Campus, Ann Arbor, Michigan Cardiology Locations Ann Arbor Ypsilanti Brighton 700 Towner Saint Joseph Mercy Woodland Health Center at St. Joseph Mercy Hospital Ypsilanti, MI Grand River, Suite Elliott Drive, Suite Brighton, MI Ann Arbor, MI Adrian Canton 1548 W. Maumee, Suite C Saint Joseph Mercy Canton Health Center Adrian, MI S. Canton Center, Suite Canton, MI Jackson Livonia 309 Page Avenue Marian Pavillion Jackson, MI Levan Rd., Suite Livonia, MI Vascular Surgery Locations Ann Arbor Saline Brighton Saint Joseph Mercy Saint Joseph Mercy Woodland Health Center at St. Joseph Mercy Hospital Saline Hospital 7575 Grand River, Suite Elliott Drive, Suite Russell Street Brighton, MI Ann Arbor, MI Meister Building, Suite Saline, MI Cardiovascular & Thoracic Surgery Location Ann Arbor at St. Joseph Mercy Hospital 5325 Elliott Drive, Suite 102 Ann Arbor, MI INTERVENTIONAL RADIOLOGY Location Ypsilanti Saint Joseph Mercy Reichert Health Centter 5333 McAuley Drive Suite 6016 Ypsilanti, MI For additional information, please call or visit