Investing in You

Adena Health System Annual Report 2013

Table of Contents President’s Letter

INVESTING IN OUR PATIENTS

6-8 Clinical Integration

9 GME Clinic Brings Value to Patients and Physician Residents

10-13 Innovation Keeps Adena on the Cutting Edge

14-17 Adena Welcomes Our New Providers

18-19 Adena Lung Cancer Screenings

INVESTING IN OUR COMMUNITY

20-21 Healthy Moms and Babies

22 Adena Care and CHNA Reports

23 Service Excellence Initiative

24 Physician Recognition

25 DAISY Award Recognizes Outstanding Nurses

26 Board Members & Leadership

27 Financials

3 President & CEO’s Letter

4 Chairman’s Letter

5 Welcome

Dear Neighbor,

I’m pleased to present Adena Health System’s Annual Report for 2013. The year was one of adaptation and progress, which resulted in better employee and physician engagement, streamlined processes, cost savings and a positive operating margin.

Adena, like all healthcare providers, is making its way through a tidal wave of change in the industry – facing new federal requirements, increased documentation, and changes to how we are reimbursed for services. However, Adena is on the right course to navigate change.

Through deliberate collaboration and planning, Adena’s clinical integration and standardization teams have reduced readmissions for heart attack, congestive heart failure and pneumonia; coordinated care for patients by creating patient-centered medical homes; and saved the organization $3.4 million by standardizing and streamlining processes across seven service lines. Our work is just beginning, but we are making a positive impact in how we deliver care for our patients and community.

Training new physicians continues to lead the mission of Adena’s Graduate Medical Education program. In 2013, the program was expanded from the Traditional Residency track, to include an Emergency Medicine track and a Family Practice track. Additional programs are expected over the course of the year. We also expect to see a boost in our nursing education program through a partnership with Ohio University, along with added research capabilities that will fully utilize our PACCAR facility simulated research labs.

Adena’s Service Excellence initiative also took root in 2013, and will wrap up this spring. Once this initiative is in place, every employee, physician, board member and volunteer will have completed “Caregiver Training,” which is intended to make the most of the experiences each employee and physician has with our patients and visitors.

Employee and physician engagement efforts also experienced great success over the past year. In Adena’s most recent Gallup Employee Engagement Survey, our grand mean score was 4.15, up from 4.08 – and every single site witnessed improved scores. Physician engagement was also up, and the number of “actively engaged” physicians rose by an impressive 10 percent, with the number of “actively disengaged” doctors dropping by 16 percent.

Adena’s employee and physician engagement success was recently recognized by Gallup, as we were selected as one of just 25 workplaces in the world to receive this year’s Gallup Great Workplace Award. The Award honors exceptional organizations whose leadership has mastered how to engage their workforce to drive real business outcomes.

I’m excited for what 2014 holds for Adena – and I hope you are, too. We promise to do everything we can to help our patients and make them feel and believe we are here to care for them. Thank you for allowing us to serve you.

Sincerely,

Mark Shuter President & CEO Adena Health System

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Investing in Your Health

Welcome to Our 2013 Annual Report

Dear Neighbor,

In 1895, a fatal train accident just west of Chillicothe planted the roots for what would become the Adena Health System. With no nearby medical facilities, compassionate residents welcomed the injured into their homes. Vowing to never be without expert healthcare again, a small group of dedicated women raised funds for our town’s first hospital on North Bridge Street. It is in this same spirit of community engagement that Adena continues to invest in you and the region of south central Ohio.

More than a century later, you’ll still see Adena Health System’s innovative spirit at work through our pioneering medical achievements. In just over a year, Adena’s surgical teams have performed more than 300 total robotic procedures using the latest da Vinci® Surgical System. We’ve also garnered national and even worldwide recognition for performing the nation’s first state-of-the-art reverse shoulder implant surgery and for implanting one of the country’s first MRI-safe spinal cord stimulators.

Investment in our patients is also evident in our ongoing refinement of medical care protocols. Through one-on-one outreach with nurse navigators and through improved information sharing via our Meditech computer system, we’ve significantly reduced readmission rates for both extended care and Medicare patients.

We’re also investing in our patients, caregivers, and community through Adena’s Graduate Medical Education (GME) program and the Adena Family Medicine Resident Clinic. As we ushered

in our second year as a teaching hospital, we attracted the best and the brightest medical talent to our area, while also offering expert healthcare to those in dire need.

We’ve come a long way from those early days of limited healthcare options. Today, Adena Health System is a comprehensive resource shared by our friends, neighbors, co-workers, and family members. With 160 physicians and 60 nurse practitioners, we care for thousands of patients each year. In 2013 alone, we welcomed 486,000 outpatient visits, 369,000 physician visits, 104,000 emergency department and urgent care visits, and 12,500 inpatient admissions.

We also invested $27 million in information technology (IT) to meet the needs of clinicians and patients. Never again will we be without exceptional healthcare choices. From our regional medical center in Chillicothe to emergency departments, surgery centers, outpatient clinics, and primary care practices located throughout the region, we’re invested in you.

I look forward to another successful year and appreciate my fellow board members’ dedication, passion, expertise, and service. Together, we will continue to invest in you and our community with personalized healthcare that reflects our shared values.

Sincerely,

David Strickland, Chairman Adena Health System Board of Trustees

Chair’s Letter

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Thank you for your interest in Adena Health System. This year’s annual report

is dedicated to you – our friends, neighbors, co-workers, and family members.

Within the pages of this report, you’ll discover the many ways Adena Health

System is investing in you.

In 2013, we developed a number of innovative health programs that received

national recognition. Our life-saving Lung Cancer Screening program was created

and has identified lung cancer, as well as a number of other conditions such as

advanced heart disease, liver nodules, and life-threatening aneurysms. Just five

weeks after launching the program, the Adena Cancer Center was designated a

“Screening Center of Excellence.”

Adena Family Medicine in Waverly introduced a successful Patient Centered

Medical Home (PCMH) pilot program, becoming the only clinic in south central

and southern Ohio to achieve NCQA status (National Committee on Quality

Assurance). Following this success, we rolled out the pilot program to all Adena

primary care clinics. We believe all of our lives are enriched when we invest in

the health of our shared community.

Adena also received national and worldwide recognition for bringing the latest

medical technology to our region, including the nation’s first reverse shoulder

implant and one of the nation’s first MRI-safe spinal cord stimulator implants.

One of our own even became the first surgeon in southern Ohio to perform

100 single-site robotic procedures using the latest da Vinci® Si Surgical System.

While we appreciate all of the positive national recognition Adena received

in 2013, we value your trust the most. Thank you for believing in us.

“The first wealth is health.”

Ralph Waldo Emerson

Now more than ever, coordinated patient care is making a difference in the level of service a patient receives at Adena, while also meeting the new government requirements and the expectations on today’s healthcare industry. Much of the change can be attributed to more government input on how providers deliver care. However, it is also making a positive impact on the patients we serve.

Patient Centered Medical Home

To meet the needs of its patients, Adena Family Medicine – Waverly began a Patient Centered Medical Home (PCMH) pilot to guide the care of high risk, chronic disease patients through coordinated care between all of the patient’s caregivers, and one-on-one outreach by a nurse navigator. The nurse navigator works with the patient between office visits to ensure they are monitoring their condition and taking their prescribed medication. The navigator also offers easy, ongoing phone access to assist if the patient has a question or condition-related problem.

The program has been so successful that the clinic recently became the only one in south central and southern Ohio to achieve National Committee on Quality Assurance (NCQA) recognition for its PCMH initiative. “It sets us apart,” said Dr. H. Takaji Kittaka, Adena’s Chief Transformational Officer and leader of the Waverly PCMH pilot program. “Achieving a NCQA designation tells our patients that they can be assured a national body has reviewed our program, and they have determined it offers them unparalleled quality care.” The success of the Waverly PCMH pilot has led to all of Adena’s primary care clinics utilizing this methodology and each will apply for NCQA status later this year.

Clinical Integration Efforts Making Positive Impact

Investing in Our Patients: Clinical Integration

In just a few short years, Adena’s Clinical Integration initiatives have resulted in more comprehensive care for our patients, efficiency in our care delivery, and cost savings for the health system.

Transitional Care

Adena’s Transitional Care initiative is also helping to reduce readmissions in the patient population being cared for in local extended care facilities (ECF).

“We realized we were losing access to the patient after they left the hospital,” said Bambi Huffman, Vice President for Clinical Integration. The team also realized that 32 percent of the patients coming from ECFs were being readmitted for the same conditions. Huffman added, “The ECFs say the lifesaving concept for them was when we gave them access to our (Meditech) computer system, providing them with information related to the patient’s record of care. Now they can see labs, X-rays, medications and discharge summaries at their facilities, instantly.”

The Adena team meets with area ECFs monthly to understand their issues and how each can meet the needs of those patients most effectively. Since regular interaction with the ECFs began, the readmission rates for patients coming to Adena from ECFs has fallen to 21 percent. continued on next page...

Condition CMS Target Sept. 2012 Dec. 2013AMI 18.9 21.6 18.01CHF 24.4 25.9 21.5Pneumonia 19.4 21.6 19.36

Readmission Rates Falling

Since beginning a project in Sept. 2012 to reduce Medicare readmissions related to three chronic illnesses, Adena’s readmission numbers have fallen to levels below federal (CMS) targets. Led by Dr. Kirk Tucker and Bambi Huffman, Vice President for Clinical Integration, Adena’s team is seeing impressive results in developing processes and care protocols that have led to this improvement.

To reduce Adena’s Medicare readmission rates for heart attack (AMI), congestive heart failure (CHF), and pneumonia, the team studied the issue and implemented standards and processes to make sure patients vulnerable for readmission had the support they needed while they were in the hospital and after they were discharged.

One of the first steps was to assign nurse navigators to patients with Medicare who were hospitalized for any of the three chronic illnesses. The RN provides patients with education about their condition and guides them through their care while they are in the hospital. That interaction continues by phone after patients are discharged and through their follow-up care for at least 30-60 days.

“That post discharge contact with a nurse navigator is key in making sure patients stay on track after they go home,” said Dr. Tucker. “The navigator makes sure patients have the medication they need, schedules their five to seven day follow up visit, and checks in with them to find out if there are any changes to their condition.” If the nurse determines a patient’s condition is deteriorating, they will call the Primary Care Physician (PCP) to let them know the patient has a change in status. The patient’s provider can then assess and treat his or her condition, helping the patient to avoid ending up in the ER or being admitted back into the hospital.

Dr. Harry Kittaka

Bambi Huffman, RN

Dr. Kirk Tucker

“That post discharge contact with a nurse navigator is key in making sure patients stay on track after they go home...”

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Investing in Our Patients: Clinical Integration (continued)

Clinical Variation & StandardizationAdena began a physician-led initiative to reduce clinical variation and improve standardization among six major service lines including: Surgery; Cardiology; Radiology & Lab; General Medicine; Women & Children; and Rehabilitation.

To prepare for the project’s 2013 launch, six teams, along with an advisory team, conducted a series of brainstorming/planning sessions to determine and implement methodology to generate the best results for continuous quality improvement in patient care. Quarterly goals were set for each service line, with teams completing required project management documents, then locking-in their next quarter initiatives and financial estimation. Each month, the project manager tracks financial information and conducts bi-weekly huddles with the teams for status updates.

Adena’s initial 2013 goal for this project was to reduce costs and/or to enhance net revenue by $2 million. The six major teams followed the process and saved the Health System $3.4 million in 2013. Because of the project’s major success, the Clinical Variation & Standardization team plans to add four more teams in 2014.

In addition to cost savings, this program has streamlined processes – making patient care as consistent and effective as possible.

The Adena Family Medicine Resident Clinic was created in 2012 to offer patients who may have exhausted every other means, a place to find care. It also gives newly-graduated physician interns the experience of working with patients, and managing their conditions on a regular basis.

“We see people regardless of insurance. We are kind of the court of last resort,” said Dr. David Towle, director of Adena’s Graduate Medical Education (GME) Program. “If they are agreeable and compliant, we would love to take care of them forever.” As a teaching clinic, seeing patients in dire need of healthcare offers the new physicians an opportunity to practice the methods they learned in medical school, while helping patients in need of quality care. “Our patients are folks who don’t spend a lot of time and attention on their own healthcare,” added Dr. Towle. “When they do present, they are great teaching cases. We get some pretty sick folks.”

Last summer, a new group of interns began seeing patients in the clinic, as the previous year’s residents moved on to the next phase of their residencies in Emergency Medicine. “Getting those personal relationships with patients has been nice,” said Dr. Nisha Haque, a now second-year resident. “We’ve dealt with a variety of patient care issues and have learned how to distinguish who was genuine and who

really wants to take care of themselves. We’ve also learned how to communicate with patients on different levels. Not just giving orders, but relating and connecting with them.”

With a full waiting room during clinic hours, and enthusiastic physicians, the Adena Family Medicine Resident Clinic is fulfilling its mission in serving our patients, as well as our physician residents. “The clinic has been an amazing experience,” said Dr. Haque. “It’s really taught us how to be efficient. We can see up to 12 patients in just four hours. I don’t know any interns out there who do that on their own. It’s a good stepping stone for us because it just means we can improve and there’s no going back.”

Of leaving the clinic behind, Dr. Haque said, “It’s been a process for us. We helped grow this program and now we’re handing it over. It’s like having a newborn and giving it to someone else.”

The Adena Family Medicine Resident Clinic is open on Tuesdays and Thursdays from 1 to 5 p.m.

GME Clinic Brings Value to Patients and Physician Residents

Dr. Nisha Haque

“The six major teams followed the process and saved the Health System

$3.4 million in 2013.”

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Adena’s Graduate Medical Education Program welcomed its second consecutive class of physician interns in July 2013. The 12 men and women are fresh graduates of Osteopathic medical schools from across the country, each with aspirations for long, successful careers in medicine. They will spend the year as physician interns, many serving patients in the Adena Family Medicine Resident Clinic.

The innovative spirit of many Adena physicians is not only recognized here, but by healthcare entities across the nation and the world. In 2013, several Adena physicians were selected as the first to utilize new technologies, benefiting our patients and enhancing the reputation of the physicians and the Health System.

Adena Surgeon First in U.S. to Use New Shoulder Implant

In June 2013, Dr. Brian S. Cohen performed the nation’s first surgery using a state-of-the-art reverse shoulder implant on a 72-year-old man. Dr. Cohen implanted the Arthrex Reverse Universe device shortly after it was approved by the U.S. Food and Drug Administration on May 31, 2013.

Contributing to the actual design of the new implant, Dr. Cohen also teaches surgical orthopaedic techniques to other physicians. The prosthetic is more cost effective, and uses technology not previously available in reverse shoulder implants. The technology is expected to provide a better, longer lasting bond over time. Of his contributions, Dr. Cohen added, “It is nice when people take stock in what you believe is important in helping your patients have a successful outcome, and then to implement that into a prosthesis.”

Reverse shoulder implant surgery is intended to replace the ball and socket of the rotator cuff, giving the patient better range of motion.

Innovation Keeps Adena on the Cutting Edge

Investing in Our Patients: Innovation

At Adena Health System, we continually strive to expand patient treatment options. Investing in the latest technical advancement is one way we invest in you.

Dr. Brian S. Cohen

“It is nice when people take stock in what you believe is

important in helping your patients...”

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Dr. Bill Sever

Dr. Bill Sever recently became one of the first surgeons in Ohio to perform 100 single-site robotic procedures. This accomplishment comes less than a year after he began performing the innovative surgery, which uses one small incision at the patient’s navel for entry of the robotic surgical tools.

“With a single-site procedure, the patient ultimately has a small scar in the belly button area,” said Dr. Sever. “There is little discomfort and healing happens even faster than with other forms of laparoscopic and robotic surgery.”

Adena began using the da Vinci® Si Surgical System for robotic surgery in October 2012, and currently has seven surgeons trained on the technology. In just over one year, Adena’s surgical teams have conducted more than 300 total robotic procedures using the da Vinci® system.

da Vinci® Si Surgical System

Adena Surgeons Among the First to Use New Spine Stimulator

Single-site Robotic Surgery Making a Difference for Patients

Dr. Kort Gronbach

Dr. Mark Malinowski

“...Healing happens even faster than with other forms of laparoscopic

and robotic surgery.”

Investing in Our Patients: Innovation

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The physicians of Adena Pain Management were selected among the first in the nation to offer patients MRI-safe spinal cord stimulator technology. Dr. Kort Gronbach and Dr. Mark Malinowski were selected to implant the SureScan® device, with patients achieving excellent results. The Adena Pain Management duo are the only surgeons in south central and southeastern Ohio implanting the device.

“The spinal cord stimulator is like a pacemaker for the spine,” said Dr. Malinowski. Stimulator technology has been used for over 30 years, and is becoming more and more common as an effective treatment for chronic back, leg and arm pain. Dr. Gronbach added, “Spinal stimulation is probably one of the best technologies we can use to get people back to a functional state; where they are controlling their pain without medication and getting back to work.”

Spinal stimulators are used to give patients better function and symptom control for a variety of limb pain caused by injury, failed back surgeries and chronic illness, such as diabetes. The new device by Medtronic is revolutionary because it allows the patient with a spinal cord stimulator to have MRI testing if needed. Previously, patients in need of regular MRIs, such as those with Multiple Sclerosis, were not candidates for spinal cord stimulation due to the danger of the leads overheating and damaging the equipment and the patient’s tissue. The new MRI-compatible technology evenly distributes the heat created when the stimulator comes in contact with the radio waves from the MRI, eliminating past “hot spot” problems.

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EMILIA ANIGBO, MD PULMONOLOGY

Adena Pulmonology Education: University of Nigeria Nsukka/College of Medicine, University of Nigeria Teaching Hospital (UNTH), Enugu, NigeriaResidency: Internal Medicine, Oakwood Hospital & Medical Center, Dearborn, MI Fellowship: Pulmonary/Critical Care Medicine, University of Kentucky, A.B. Chandler Medical Center, Lexington, KY

PAWAN ARORA, MD HOSPITALIST

Adena Hospitalist Group Education: Government Medical College, Patiala, Punjab, IndiaResidency: Internal Medicine, Monmouth Medical Center, Long Branch, NJ

REGINA BRAY, MD FAMILY MEDICINE

Adena Chillicothe Family Physicians Education: University of Maryland School of Medicine, Baltimore, MDResidency: Family Medicine, Virginia Commonwealth University - Fairfax Family Practice, Fairfax, VA

BRUCE CHEN, MD INTERVENTIONAL CARDIOLOGY

Adena Cardiology Education: West Virginia University School of Medicine, Morgantown, WVResidency: Internal Medicine, West Virginia University, Morgantown, WV Fellowship: Cardiology, West Virginia University, Morgantown, WV; Interventional Cardiology, West Virginia University, Morgantown, WV

JENNIFER DAVIS, MD FAMILY MEDICINE

Adena Family Medicine of Chillicothe Education: The Ohio State University College of Medicine, Columbus, OHResidency: Family Medicine, Riverside Methodist Hospital, Columbus, OH

R. TODD DOMBROSKI, DO, FAAFP FAMILY MEDICINE

Adena Family Medicine – Residency ClinicEducation: Kirksville College of Osteopathic Medicine, Kirksville MOResidency: Family Medicine, Womack Army Hospital, Fort Bragg, NCFellowship: Sports Medicine, Hughston Sports Medicine Center, Columbus, GA

AUSTIN AL-KAzAz, MD HOSPITALIST

Adena HospitalistsEducation: Medical University of the Americas, Nevis, West IndiesResidency: Family Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK

MAYSA EL SAYYID, MD HOSPITALIST

Adena Hospitalist Group Education: University of Kentucky College of Medicine, Lexington, KYResidency: Family Medicine, The Ohio State University, Columbus, OH Fellowship: Hospitalist Medicine, Grant Medical Center, Columbus, OH

WAEL HAIDAR, MD INFECTIOUS DISEASE

Adena Infectious Disease Education: Universidad IberoAmericana, Doctor of Medicine, Santo Domingo, Dominican RepublicResidency: Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL Fellowship: Infectious Disease, University of Kansas Medical Center, Kansas City, KS

Adena Welcomes Our New HealthCare ProvidersIn 2013, 50 providers joined Adena Health System, to care for patients in locations throughout our 12-county service region. We are pleased to have found many of our nation’s best and brightest caregivers, who are offering life-impacting treatment and care to the people we serve. We are grateful you are here, and extend a warm welcome to each of you.

JENNIFER GWILYM, DO FAMILY MEDICINE

Adena Family Medicine–Residency ClinicEducation: Ohio University College of Osteopathic Medicine, Athens, OHResidency: Family Medicine, Doctors Hospital, Columbus, OH

LONG LE, MD HOSPITALIST

Adena Hospitalist Group Education: St. Matthews University, Cayman IslandsResidency: Internal Medicine, Hahnemann University Hospital/Drexel University, Philadelphia, PA

JOSEPH KEARNS, DO, MPH OCCUPATIONAL MEDICINE

Adena Occupational HealthEducation: University of Health Sciences, College of Osteopathic Medicine, Kansas City, MOResidency: Occupational Medicine, University of Michigan, Ann Arbor, MI

JOHN KELLER, MD ELECTROPHYSIOLOGY

Adena Cardiology Education: University of Cincinnati College of Medicine, Cincinnati, OHResidency: Internal Medicine, The Ohio State University Medical Center, Columbus, OH Fellowship: Cardiology and Electrophysiology, The Ohio State University Medical Center, Columbus, OH

JENNIFER KELLER, MD INTERVENTIONAL CARDIOLOGY

Adena Cardiology Education: The Ohio State University College of Medicine, Columbus, OHResidency: Internal Medicine, The Ohio State University Medical Center, Columbus, OH Fellowship: Cardiology and Interventional Cardiology, The Ohio State University Medical Center, Columbus, OH

JUDITH KNOLL, DO EMERGENCY MEDICINE

Adena Emergency Medicine – Residency Clinic Education: West Virginia School of Osteopathic Medicine, Lewisburg, WVResidency: Emergency Medicine, UPMC Hamot Medical Center, Erie, PA; Family Medicine, Wheeling Hospital, Wheeling, WV

BONNIE MCKINLEY, DO ORTHOPEDIC MEDICINE

Adena Bone and Joint CenterEducation: Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, CAResidency: Family Medicine, Aria Bucks Hospital, Langhorne, PAFellowship: Sports Medicine, Atlantic Health Care, Clark Sports Extra, Clark, NJ

JENNIFER NEY, DO HOSPITALIST

Adena Hospitalist GroupEducation: University of Osteopathic Medicine and Health Sciences - Des Moines, IAResidency: Internal Medicine, Oakland General Hospital, Madison Heights, MIFellowship: Pulmonology/Critical Care, Genesys Regional Medical Center, Grand Blanc, MI

zION OSHIKANLU, MD HEMATOLOGY/MEDICAL ONCOLOGY

Adena Cancer Center Education: University of Ilorin, NigeriaResidency: Internal Medicine, Columbia University College of Physicians and Surgeons at Harlem Hospital Center, New York, NY Fellowship: Hematology/Oncology, Michigan State University, Breslin Cancer Center, Lansing, MI

OWAIS IDRIS, MD HOSPITALIST

Adena Hospitalist Group Education: American University of the Caribbean – School of Medicine, St. Maarten, Netherlands AntillesResidency: Internal Medicine, St. Vincent Mercy Medical Center, Toledo, OH

JULIA HARLAN, MD HOSPITALIST

Adena Hospitalist Group Education: The University of Toledo College of Medicine, Toledo, OHResidency: Internal Medicine, The University of Iowa Internal Medicine Program, Iowa City, IA

VISHAL PATEL, MD PULMONOLOGY

Adena Pulmonology, Critical Care & Sleep Education: Pramukhswami Medical College, Sardar Patel University, Karamsad, Gujarat, IndiaResidency: Internal Medicine, New York Methodist Hospital, Brooklyn, NY Fellowship: Pulmonary-Critical Care, Division of Pulmonary/ Critical Care Medicine, New York Methodist Hospital, Brooklyn, NY; Sleep Medicine, Division of Sleep Medicine, Hospital of University of Pennsylvania, Philadelphia, PA

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JEYANTHI RAMANARAYANAN, MD HEMATOLOGY/MEDICAL ONCOLOGY

Adena Cancer Center Education: Sri Ramachandra Medical College and Research Institute, Porur, Chennai, IndiaResidency: Internal Medicine, Mount Sinai School of Medicine, Jersey City, NJ Fellowship: Oncology, Roswell Park Cancer Institute, Buffalo, NY; Hematology, University at Buffalo at Erie County Medical Center, Buffalo, NY

RONALD RISH, MD ENT

Adena ENT & AllergyEducation: University of Florida, College of Medicine, Gainesville, FLResidency: Otolaryngology Head and Neck Surgery, Naval Hospital, San Diego, CA

GARRETT SESSIONS, DPM PODIATRY

Adena Bone and Joint Center Education: Scholl College of Podiatric Medicine, Rosalind Franklin University School of Medicine & Science, North Chicago, ILResidency: Podiatric Medicine, Oakwood Healthcare System, Dearborn, MI

CARL PUNLA, MD HOSPITALIST

Adena Hospitalist Group Education: Fatima College of Medicine Valenzuela City, Manila, PhilippinesResidency: Family Medicine, University of Medicine and Dentistry of NJ; Robert Wood Johnson Medical School, CentraState Medical Center, Freehold, NJ

JOHN PERALTA-OLIVIERI, MD URGENT CARE

Adena Urgent CareLocation: Adena Health Center–Western Ave Residency: Family Medicine, Cook County - Loyola - Provident, Chicago, ILFellowship: Urgent Care, University Hospitals, Urgent Care, Cleveland, OH

ROSE TRESS, MD HOSPITALIST

Adena Hospitalist Group Education: Ross University School of Medicine, Dominica, West IndiesResidency: Family Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK

CHRISTIN SPAHN, MD GENERAL SURGERY

Adena SurgicalEducation: Northeastern Ohio Universities College of Medicine, Rootstown, OHResidency: General Surgery, Chief Surgical Resident, Akron City Hospital, Akron, OH

ALIX TERCIUS, MD INTERVENTIONAL CARDIOLOGY

Adena Cardiology Education: Ross University School of Medicine, Dominica, WIResidency: Internal Medicine, University of Connecticut Health Center, Farmington, CT Fellowship: Cardiology, Aurora Healthcare/University of Wisconsin, Milwaukee, WI; Heart Failure, St Francis Hospital, Hartford, CT; Interventional Cardiology, The Ohio State University, Columbus, OH

ASHISH UPADHYAY, MD ORTHOPEDIC SURGERY

Adena Bone and Joint Center Education: Medical School (MBBS), University of Delhi, IndiaResidency: Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL Fellowship: Spine and Spinal Deformity Surgery, Leatherman Spine Center, Louisville, KY

VICTORIA zYSEK, DO CARDIOLOGY

Adena Cardiology Education: The Lake Erie College of Osteopathic Medicine, Erie, PAResidency: Internal Medicine, The Cleveland Clinic Foundation, Cleveland, OH Fellowship: Cardiology, Advocate Lutheran General Hospital, Park Ridge, IL; Preventive Cardiology Subspecialty, Mayo Clinic, Rochester, MN

MARY KATHY BROOKS, CNP GASTROENTEROLOGY

Adena Gastroenterology Education: University of Cincinnati, Cincinnati, OH

CASEY CLEVENGER, CNP PRE-ADMISSION TESTING

Adena Pre-Admission TestingEducation: Case Western Reserve University, Cleveland, OH

JENNIFER DUNCAN, CNP FAMILY MEDICINE

Adena Jackson Family Practice & Pediatrics Education: Otterbein University, Westerville, OH

JAMI EASTERDAY, CNP FAMILY MEDICINE

Adena Pickaway-Ross Family Physicians Education: Otterbein University, Westerville, OH

MELISSA FLORES, CNP FAMILY MEDICINE

Adena Family & Internal Medicine Waverly Education: Ohio University, Athens, OH

JESSICA HUBBARD, CNP FAMILY MEDICINE

Adena Pickaway-Ross Family Physicians Education: Frontier Nursing University, Hyden, KY

JOYCE KRECH, CNP FAMILY MEDICINE

Adena Pickaway-Ross Family MedicineEducation: Ohio University, Athens, OH

JASON JONES, CNP PULMONOLOGY

Adena PulmonologyEducation: Wright State University, Dayton, OH

KIM PULLINS, CNP PULMONOLOGY

Adena Pulmonology Education: Wright State University, Dayton, OH

BETSY SHAFFER, CNP FAMILY MEDICINE

The Clinic at Walmart – Washington Court House Education: The Ohio State University, Columbus, OH

MICHELLE SMITH, CNP PEDIATRICS

Adena Pediatrics Education: The Ohio State University, Columbus, OH

ANDREW VARNEY, CNP FAMILY MEDICINE

Adena Chillicothe Family Physicians Education: Otterbein University, Westerville, OH

LISA VIRES, CNP PODIATRY

Adena Bone and Joint CenterEducation: Ohio University, Athens, OH

CRAIG LUEHRS, CRNA ANESTHESIOLOGY

Adena AnesthesiologyEducation: University of Miami, Coral Gables, FL

DOUGLAS MORAVEK, CRNA ANESTHESIOLOGY

Adena AnesthesiologyEducation: University of Akron, Akron, OH

SHAKIRA BOUY, CRNA ANESTHESIOLOGY

Adena AnesthesiologyEducation: Villanova University, Villanova, PA

SERENA MILLER, CNP FAMILY MEDICINE

Adena Pickaway-Ross Family Physicians Education: Wright State University, Dayton, OH

BRANDON WARD, CRNA ANESTHESIOLOGY

Adena AnesthesiologyEducation: Mountain State University, Beckley, WV

LESLEY MANSON, CNP OBSTETRICS AND GYNECOLOGY

Adena Obstetrics and Gynecology Education: University of Cincinnati, Cincinnati, OH

Last fall, Adena Health System began offering lung cancer screenings for patients most at risk for the number one cancer killer. Lung cancer screening is a simple, painless, low dose CT chest scan, and with early screening and detection, those in the screening population who are without symptoms have a lung cancer survival rate of up to 80 percent.

According to the Ohio Department of Health, one-in-four of those living in Ross County are smokers. Patients who benefit most from lung cancer screening are:

• Betweentheagesof55-74;

• Quitsmokingfewerthan15yearsago;and

• Have30“packyears”ofsmokingintheirrecentordistantpast.A“packyear” is calculated by taking the number of packs of cigarettes smoked per day and multiplying it by the number of years the person smoked. Therefore, a two-pack a day smoker, who smoked for 15 years is considered a 30-pack year smoker and should be tested.

Adena’s positive tests represent a rate of cancer in about six percent of our scans, which is about 3.5 times the national average (1.8 percent). “On average, seven lives are saved for every 100 scans you do,” said Dr. Jeffery VanDeusen, Medical Director of the Adena Cancer Center. In addition to lung cancer, the scans are finding life-threatening aneurysms, advanced heart disease, liver nodules, tumors and quite a few lung nodules. Patients with these conditions are referred to Adena specialists who help them manage their conditions.

“This is where you really save lives,” said Dr. VanDeusen. “It’s not just lung cancer you find with this test. That’s why it’s such a powerful screen.” Response to the screening program has been overwhelming, far exceeding expectations and the numbers of larger metropolitan health providers. A key to the program’s early success is undoubtedly the availability of the screen, which is currently being provided at no cost to the patient.

The lung cancer screening program has been a true collaboration with many departments throughout the health system, and is making an impact on the patients we serve. If you, a loved one, or a co-worker falls into the recommended test group, consider setting up a lung cancer screening today by calling (740) 542-LUNG (5864).

Adena Offers Life-saving Lung Cancer Screening

Investing in Our Patients: Life-saving Screening

Investing in our patients through coordinated screening programs saved lives in 2013, and earned Adena Health System national recognition.

Dr. Jeffery VanDeusen

Adena’s Program Gets National RecognitionJust five weeks after beginning the Lung Cancer Screening Program, the Adena Cancer Center was designated a “Screening Center of Excellence” by the Lung Cancer Alliance, the nation’s leading lung cancer advocacy group. The organization designates Centers of Excellence to identify the places a patient can go for a lung cancer screening that will offer them well-coordinated care and disease management.

“I’m really proud of this,” said Dr. Jeffery VanDeusen, Medical Director of the Adena Cancer Center. “We felt that we had done a really wonderful job creating this lung cancer screening program. By receiving this official stamp of approval from Washington, D.C., it shows that we truly have an excellent program here.”

“It’s not just lung cancer you find with this test. That’s why

it’s such a powerful screen.”18 19

Over the past few years, Adena, like nearly every hospital, has experienced a significant increase in the number of babies born addicted to opiates. While it was not unusual to see a baby born positive for cocaine or marijuana over the past few decades, there was a drastic increase about three years ago of drug-addicted mothers delivering babies that were addicted to heroin and other opiates.

“It’s not just an Adena problem. It’s a national problem,” said Jackie Rebman, RN, MSN, Director of Specialty Services. “We recognized that with the mom battling addiction, we often had a baby who was also addicted. In the past, we would send the infant to Nationwide Children’s for treatment; make a Children’s Services referral, and pretty much be forced to not think about it. However, as nurses and caregivers, we all struggled with that process. We weren’t really doing anything proactively to help the mom – and we definitely weren’t helping the baby.”

Those feelings were the foundation for many of our caregivers to start thinking about how we can get in at the front end of this problem. Led by Adena Pediatrician Dr. Amy Luckeydoo and others, the group applied for and received a CareSource grant to start a program intended to help the moms get off street and prescription opiates before they delivered their babies.

The program began on February 25, 2013, and provides the moms-to-be with support from: an Adena social worker; doctors (Luckeydoo, Ross, and Lopez); and nurses (Peggie Marcum, Beth Kraft and Brenda Pettay); along with weekly group meetings with other pregnant women who are trying to deliver babies that will not be born addicted to opiates.

“Most of the moms in the program are heavy users,” said Program Facilitator Donna Collier-Stepp, MSW, LSW, HO, an Adena social worker. “It’s difficult to get them all the way off of the drug before they deliver. So what we do is manage it. We put them on Subutex, a synthetic opiate that is safer for the fetus. We give them regular doses and manage those doses through the pregnancy.” Once the baby is delivered, the new mom is switched to Suboxone, another synthetic opiate, and is given lower doses over time to get over the addiction. The entire process takes about two years.

Program Helping Drug-addicted Moms Deliver Healthy Babies

Investing in Our Community: Healthy Moms and Babies

Adena Health System invests in moms, babies, and the community through an innovative new program that helps moms battle addiction before they give birth. The success of the program positively impacts the next generation and the future of our community.

“It’s not just an Adena problem. It’s a national problem.”

So far, no woman on the program has delivered a baby that has required morphine, used to comfort the infant during the withdrawal process. Typically, an opiate-addicted infant requires hospitalization and extended care in the nursery from two weeks to 60 days. Thanks to the Subutex program, the 12 infants born to 11 of the program’s participants have not had to endure the painful withdrawal process that is common in opiate-addicted infants. As part of the program, the babies are kept in the nursery for five days for monitoring and released if all is well.

Donna credits the program’s success to its format and strict guidelines. “Many other programs meet once a month,” she said. “Our program requires the women to meet with us once a week. If they don’t come to the meeting, they won’t receive their prescription (of Subutex) for the week.” They can expect a random drug screen, and are required to also join a local addiction group such as Narcotics Anonymous or Alcoholics Anonymous, where they get a sponsor who can be there for them when the urge to use comes. In addition, there is group work during the sessions where social workers teach life skills and other ways to cope with stress and the triggers that bring on the need to use.

The program is not for everyone. Donna said one woman came to her first meeting and was up front with the social worker and said, “This sounds too hard.” She left that night. Others have attended one meeting, received a prescription and have never come back. “We’re pretty strict with the program,” said Donna. “We have had seven individuals we had to release for positive screens. Two of the women were released after they had their babies, though neither of their infants had to be put on morphine. So we didn’t have success with the mother, but we did have success with the infants.”

Adena has been approved for another grant from the March of Dimes and the State of Ohio’s Medicaid Program to expand the program. “We are starting a second group – and already we have enough people waiting to fill it. The demand far exceeds what we are able to provide,” said Donna. That second group is expected to start meeting later this spring.

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Investing in Our Community: A Focus on Outcomes

Identifying healthcare needs helps Adena Health System develop programs tailored to both its employees and members of the community.

Every patient deserves outstanding care and service. To enhance Service Excellence, every Adena physician, leader and employee is undergoing Caregiver training to reinforce customer service skills that are important to a positive patient experience. “There are many things that are outside of our control in healthcare,” said Adena’s Chief Learning Officer Gail Games. “What we do have control over is the way we treat our patients, guests and each other.”

Caregiver training instructors teach what many would call “common sense customer service” practices. The course focuses on treating our customers – the patients, visitors and each other the way we and our families would want to be treated. Things as simple as acknowledging our patients and visitors by making eye contact or saying, “Hello” or “May I help you?”

“The class is very practical and very basic, but it includes a lot of the things we forget during the day-to-day,” said Mike Diener, director of Adena Home Care. “We get busy and don’t think about how people perceive us – even when we’re walking down the hall.”

“I wish we had done this a long time ago,” said Tiffany Colopy, RN, Unit 3B Nurse Manager. “Sometimes the smallest things can make the biggest difference. Extra courtesy will improve both the patient and caregiver experience.”

“These are the things our mothers and grandmothers taught us,” added Dr. Richard Mizer of Adena Family Medicine Greenfield. “We often get so caught up in our day-to-day duties and multi-tasking that we forget the importance of the human touch and exhibiting true compassion. Each of us needs to be appreciative of the patients we have the privilege of taking care of.”

“I think the theme of getting back to basics is so simple, yet so important,” said Dr. Eric Schiffman of Adena Bone & Joint. “Basically, treating patients how you would want to be treated as a patient is paramount. We are lucky to work for Adena, and we should want our patients to feel the same pride we do.”

Games added, “By creating a positive experience for customers through all of our interactions, we hope to influence our patients’ and community’s perception of Adena.”

Service Excellence Initiative Focuses on Caregiving

Investing in Our Community: Treating You With Respect

With an ongoing focus to invest in our patients and our community, each of Adena Health System’s employees and physicians have undergone caregiver training. The training spotlights simple ways to extend courtesy and respect to everyone we meet.

“By creating a positive experience for customers through all of our interactions, we hope to influence our patients’ and community’s perception of Adena.”

As the cost of employee benefits continues to rise, Adena Health System has turned to an innovative program, called Adena Care, to help manage expenses and improve employee health. The program takes an integrated, proactive approach to employee health by identifying medical needs and by referring employees to the most appropriate healthcare available.

Eric Hales, Executive Director of Adena Care, describes the program as outcome focused and quality based with an emphasis on helping patients manage chronic conditions effectively. One successful strategy involves identifying employees that use the emergency room in place of a primary care physician. Adena Care helps match these employees to a primary care physician who can better monitor their healthcare needs. As a result, forty percent of Adena employees who did not have primary care providers now have an ongoing relationship with a primary care physician.

According to Hales, Adena Care reduced Adena Health System’s health benefit costs by 30% from 2012 to 2013. That’s a $6.1 million savings. The team continues to work with the Human Resources department to create incentives to encourage employees to improve their health.

Adena Care offers an operations manager to help employees with customer service, claims and benefit questions. Two full-time medical management nurses coordinate care with physicians and work with the physicians’ staff to proactively manage chronic diseases and close gaps in care where they exist. Staff also follows up with hospitalized employees to identify possible problems early. Recently, an Adena Care nurse helped an employee with a potentially dangerous blood sugar level spike secure an immediate doctor’s appointment rather than wait three weeks for a scheduled appointment. This level of advocacy illustrates how Adena Care benefits both employee and employer.

With the largest hospital and corporate expenses today being employee pay and benefits, the success of Adena Care makes it an attractive option for other employers as well. Hales says they are actively promoting their services to other large employers in the Chillicothe area. “Adena Care is the link between the employee and their provider to help improve overall health and wellness,” says Hales. “The entire Adena Care team is excited to be part of Adena Health System’s efforts to coordinate care for better outcomes and lower costs.”

Benefits of Adena Care Community Input Crucial to Assess Health NeedsAs part of the 2010 Affordable Care Act, the IRS requires all 501(c) (3) nonprofit hospitals to complete a Community Health Needs Assessment (CHNA) at least once every three years, and to make these reports accessible to the public. This assessment is intended to support the development of future community health improvement strategies and planning.

In 2013, Adena Health System, supported by its many community partners, completed a Community Health Needs Assessment (CHNA) for its hospitals located in Chillicothe, Greenfield and Waverly. Conducting these assessments, and making them available to the public, meets our obligation under the new federal requirements and offers healthcare providers a clearer picture of the health needs of our population.

All three of Adena’s CHNA reports identify obesity as a critical issue in our region. Obesity increases the likelihood of various diseases including: diabetes, heart disease, osteoarthritis and cancer. By working collaboratively within the Health System, and with others in our community and state, Adena plans to play an active role in addressing the challenges of this epidemic. Adena’s CHNA reports are available at www.adena.org/chna.22 23

DAISY Award Recognizes Outstanding Nurses

Investing in Our Community: Top-notch Caregivers

Adena’s nursing staff is among the nation’s best. In 2013, Adena began recognizing nurses who went above and beyond with one of the nation’s most prestigious nursing awards, the DAISY.

The DAISY Award for Extraordinary Nursing was founded by the family of 34-year-old Patrick Barnes. The family was overwhelmed by the level of passion and care his nurses provided during Barnes’ eight-week hospitalization for immune thrombocytopenia (ITP), which ultimately took his life.

To honor those nurses, the family founded DAISY, an acronym for Diseases Attacking the Immune System. The Barnes family believes nurses are unsung heroes who deserve far more recognition and honor than they receive. The DAISY was their way to say “thank you” to nurses around the country.

DAISY AWARD RECIPIENTS

Heather Braden, RN, has been with Adena for two years, and was selected as Adena’s first-ever DAISY Award winner for the care she provides to our pediatric patients in Adena’s Women and Children’s Unit. Her nominator, Sarah Fallow, RN said, “Heather saw that our pediatric patients were struggling with food and what they wanted to eat. She worked with Dietary to create a kid-friendly menu where the patients could choose any meal, allowing sick children to eat what sounds good to them.”

Heather responded, “This is what I love to do. I love kids and I’m going to keep providing for my patients and give them what they need. And if they need anything else, I’m going to try to push for that.”

Sabrina Stiffler, RN, a pediatric triage nurse with Adena Pediatrics, is Adena’s second DAISY Award winner. She was nominated after she heroically guided a family through a frightening and potentially deadly situation brought on by

a small peanut. In 10 years of nursing, she said she received “one of the most emergent” calls she had ever experienced when a young patient’s mother called to say her severely-allergic child had just ingested a peanut M&M. After the child received an injection of life-saving epinephrine at home, Sabrina advised the family to get the boy to the Emergency Department right away. She then called the ED to let them know the boy was on his way, giving them his medical history. When he arrived at the ED, staff was waiting and took care of him immediately. “Mom said this was the best situation they had [when dealing with the child’s peanut allergy] so far,” said Sabrina. “She said because everything was taken care of so much sooner, it prevented the boy from having to be hospitalized.”

Wayne Willburn, RN, always knew he wanted to work in the field of medicine. But after high school he did what a lot of young men do: he went to work in construction and then a factory. He eventually went on to achieve his dream and became a nurse. Wayne was recognized with the DAISY Award after being nominated by a patient who was impressed with the care he provided to her. Marcia Wykoff was in the hospital for a procedure and was very nervous about it. Wayne was her nurse, and she said he immediately made her “feel comfortable, explaining each step of the process.” When presented with the DAISY Award, Wayne said he remembered Marcia and added, “I treat everyone like I would treat a member of my own family – my wife, my mom or my daughter.”

Congratulations to all of our DAISY winners!24 25

A lot has changed in the 32 years that Dr. Ralph Roach has been on staff with Adena Health System. During his tenure, Adena’s cancer program has grown over time from several rooms on 3B in the hospital, to an eventual free-standing, state-of-the-art cancer center solely dedicated to serving the needs of patients undergoing their treatment and recovery journey.

The technology and treatment for cancer has also changed in those 32 years. “When I first started to practice, the overall cure rate for cancer was maybe 50 percent, then it went to 60 percent, now we’re approaching a 70-percent cure rate,” said Dr. Roach. “We have a ways to go, but we’ve made massive improvements.”

“We’ve seen many cancers – not all – where the improvement is terrific,” he added. “For instance with chronic myelogenous leukemia, the average outlook for a patient in 1998 was about three years. We now have targeted drugs available that have made a difference in people’s lives. I have patients who were diagnosed in 1998 who are still alive and in complete remission because of participation in a clinical trial using a targeted drug.”

Dr. Roach is also very proud of the new Palliative Care Unit recently opened under his watch as Medical Director for the program. In addition, Dr. Roach joined Dr. John Seidensticker as Adena Hospice Medical Director two years ago, a role that has given him a great deal of satisfaction.

With many accomplishments in the care he’s provided to his patients over the years – and his many contributions to Adena – Dr. Roach has set a date for the next phase of his life. He will retire on August 29, 2014.

“I have always sought to make myself dispensable, because I always knew that something might come up in my life where I would have to be more

available to my family,” he said. “I’ve always made sure to have associates, in any component of my professional career, that if some family emergency would come up, I would be able to make a transition quickly.”

That plan went into effect for Dr. Roach in 2001 when his wife, Dr. Jane Roach was diagnosed with breast cancer. “When she was diagnosed, I was able to get on the phone and cut my schedule in half in about 30 minutes to be more available for her,” he said. “I always knew something might happen, I just didn’t know what it would be. It could have been myself, it could have been one of my children, or a parent.”

Now Dr. Roach is ready to put his plan back in action to make more time for himself and his family. “I decided a long time ago that I was going to pick an arbitrary time to retire, and it wasn’t going to be dependent on circumstances,” he said.

By retiring, he and Jane are anxious to spend more time with their first grandchild, Maggie, who was born last October. The family is also looking forward to enjoying the outdoors by hiking and biking as often as they can; and continuing their service to the Chillicothe community. The couple works with patients at the Hope Clinic twice a month and they do a great deal of outreach and ministering through their church community at Walnut Street United Methodist Church.

Dr. Roach acknowledges that saying goodbye to his patients has been very difficult. He has been methodical in letting them know of his pending retirement for several months. “Those patients I see once a year, I’ve been saying goodbye and turning them over to my associates,” he said. “Now I’ve started saying goodbye to the patients I see on a six-month basis. There have been tears of sadness as well as congratulations.”

By making himself dispensable, Dr. Roach is comfortable with his decision to retire. “The program is bigger than me,” he added. “I know when I’m retired this cancer program is in excellent hands.”

Dr. Ralph Roach to Begin Making Time for His Family and CommunityPhysician Recognition

Heather Braden, RN

Sabrina Stiffler, RN

Wayne Willburn, RN

EXECUTIVE LEADERSHIPMARK SHUTERPresident and CEO

NICK ALEXANDERVice President, Adena Regional Medical Center

DAWN BENNETT JOHNSONInterim Chief Financial Officer

ERIC CECAVAVice President, Regional Administration

GAIL GAMESChief Learning Officer

MICHAEL GLANzMANVice President, Adena Medical Group

JUDITH HENSON Chief Nursing Officer

BAMBI HUFFMAN, RN Vice President, Clinical Integration

MARTHA LIVINGSTON Chief Strategy Officer

ERIC PERDUEChief Human Resource Officer

MICHAEL RHODESVice President, Revenue Cycle

PAT ROAMChief Compliance Officer

DAVID SPIALTER Interim General Counsel

LINN WEIMERChief Strategic Information Officer

MEDICAL STAFF LEADERSHIPJOHN FORTNEY, MDChief Medical Officer

JACK BERNO, MDPast Chief

L. WAYNE COATS, DO Division Chair, Inpatient Medicine

ANTHONY FREEMAN, DOChief of Staff

JUDI HENSONChief Nursing Officer

SATHISH JETTY, MDDivision Chair, Women’s and Children’s

H. TAKAJI KITTAKA, MDChief Transformational Officer

JAMES MANAzER, MDDivision Chair, Surgical Services

KIRK TUCKER, MDChief Quality Officer

JOHN YOUNG, MDDivision Chair, Cardiology and Oncology

2013 BOARD OF TRUSTEESDAVID STRICKLAND, CHAIR Trinity United Methodist

TOM WHITE, VICE CHAIR At-Large

MIKE LILLY, SECRETARY At-Large

STEVEN P. BURKHARDT, TREASURER At-Large

JACK BERNO, MD Trustee-at-Large

L. WAYNE COATS, DO Medical Staff Representative

RALPH D’ANTONI, JR. St. Mary’s Catholic Church

GARY EVANS Orchard Hill United Church of Christ

REV. JAMES GROVE First Presbyterian Church

JERRY PHILLIPS Tabernacle Baptist Church

W. BILL SEVER, DO Medical Staff Trustee

JOSEPH SULzER St. Peter’s Catholic Church

GAIL TAYLOR St. Paul’s Episcopal Church

NOBLE YOSHIDAWalnut Street UMC

S Y S T E M L E A D E R S H I P REVENUE & EXPENSES

OUR TOTAL REVENUES: 2013 2012 2011 (final)

Bills submitted to Medicare, Medicaid, individuals and commercial insurance companies for care we provided ...................................$1,007,665,765 $949,170,018 $864,934,173

Gain in market values of investments and income from non-patient care services ................................................................... $23,525,197 $26,962,619 $4,794,521

Funds drawn from prior years’ earnings ................................................................................................... — — $8,558,082

FROM TOTAL EARNINGS, WE DEDUCTED:

Charges associated with providing care to patients whowere unable to pay for their care (charity care) ............................................................. $39,730,478 $36,171,873 $41,059,418

Discounts to Medicare, Medicaid, etc. ............................................................................... $539,750,176 $503,154,707 $444,083,837

Charges associated with those patientswho refused to pay (bad debt) ................................................................................................ $27,280,761 $29,621,949 $34,351,874

THE TOTAL FUNDS AVAILABLE WERE: ..................................................... $424,429,547 $407,184,108 $358,791,647

THESE FUNDS WERE USED:

To pay employees wages and benefits ............................................................................ $228,088,048 $225,092,450 $202,840,061To buy patient care and other supplies .............................................................................. $64,927,712 $63,942,103 $61,340,019To pay for utilities and similar expenses ............................................................................. $74,872,898 $73,135,881 $64,138,483To pay professional fees for services to patients .............................................................. $3,978,165 $6,475,328 $2,607,624For depreciation of equipment, buildings and property ........................................ $21,986,231 $23,976,783 $18,544,727To pay interest expense and amortization .......................................................................... $9,695,124 $9,785,885 $9,320,733Debt –restructuring costs ................................................................................................................................ — — —Decline in market values of investments................................................................................................ — — —To provide for future services to the community ......................................................... $20,881,369 $4,775,678

THE TOTAL FUNDS APPLIED WERE: $424,429,547 $407,184,108 $358,791,647

OUR BALANCE SHEET ASSETS 2013 2012 2011

Current assets ................................................................................................................................... $158,237,735 $139,812,602 $134,412,114Other assets ....................................................................................................................................... $315,077,789 $312,083,179 $301,544,086

TOTAL ASSETS $473,315,524 $451,895,781 $435,956,200

LIABILITY AND NET ASSETS

Current Liabilities .............................................................................................................................. $46,727,675 $46,270,266 $36,441,935Long-Term Liabilities..................................................................................................................... $175,977,406 $185,959,971 $195,483,944Net Assets ............................................................................................................................................ $250,610,443 $219,665,544 $204,030,321

TOTAL LIABILITIES AND NET ASSETS $473,315,524 $451,895,781 $439,956,200

F I N A N C I A L S

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272 Hospital Road, Chillicothe, OH 45601 • adena.org