Keystonec o l o r a d o

Keystone ResoRtKeystone, ColoRado

septembeR 21-23, 2011

Physician hosPitals:leading health care

into the future

Physician Hospitals of America

11th Annual Conference & Exhibits

Join us in

Preliminary Program

Who Should Attend?

• All physician owners, physicians considering ownership, physicians considering new hospital models, medical directors, and nurses involved in physician-owned hospitals.

• those involved in or interested in the development and/or conversion of physician-owned hospitals.

• Individuals and businesses involved with physician-owned hospital development and management (e.g., Ceos, CFos, quality assurance professionals, development companies, architects, financers, etc.).

• Joint venture hospital leaders involved in establishing physician/hospital partnerships.

ACCRedItAtIon StAteMentS

Keystone, Coloradofor the PHA 11th Annual Conference & Exhibits

the PhA Board of directors is excited to invite you to Physician hospitals of America’s 11th Annual Conference & exhibits.

Whether you are a physician, medical director, Ceo, CFo, nursing director, or play another role in hospital management, the conference has much to offer.

• Receive the latest and most up-to-date information to help you provide the best patient care.

• Acquire tools and resources to improve clinical and business operations.• explore key elements in complying with industry-specific laws and

regulations.• understand options regarding development and expansion in the current

political environment.• learn more about the importance of participating in advocacy efforts to

aid in the continued perseverance of our industry.• discover new and innovative ways of providing quality patient care

through a focus on quality management and improvement.• Meet with others in the field through a range of networking

opportunities.

As physician-owned hospitals, we acknowledge that our flexibility as a result of physician governance continues to represent the best in the health care industry. With physicians leading the way, we offer a better choice for patients.

Show your support for the industry by attending Physician hospitals of America’s 11th Annual Conference & exhibits. We know you will discover new ideas and a greater appreciation of our role in the health care industry. We hope to see you at the Keystone Resort from September 21 – 23!

Sincerely,Michael e. Russell, II, Md, President, Physician hospitals of AmericaJohn R. harvey, Md, Annual Conference Co-ChairPaul Kerens, President elect, Annual Conference Co-Chair

CME Accreditationthis CMe activity has been planned and implemented in accordance with the essential Areas and Policies of the Accreditation Council for Continuing Medical education (ACCMe) through the Joint Sponsorship of the Institute for Medical Studies (IMS) and Physician hospitals of America (PhA). IMS is accredited by the ACCMe to provide continuing medical education for physicians. IMS designates this educational activity for a maximum of 13.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the conference.

nurses may claim credit for activities approved for AMA PRA Category 1 Credits™ in most states, for up to 50 percent of the nursing requirement for recertification. this activity is designated for up to 13.25 AMA PRA Category 1 Credits™. nurses should only claim credit commensurate with the extent of their participation in the conference.

American College of Medical Practice executives (ACMPe) accepts AMA PRA Category 1 Credits™ from organizations accredited by ACCMe. the provider of this program, Institute for Medical Studies, is accredited by the ACCMe and designates this educational activity for a maximum of 13.25 AMA PRA Category 1 Credits™. Administrators should only claim credit commensurate with the extent of their participation in the conference.

Join Us in Beautiful

conference informationPhA leAdeRShIP GeneRAl ConFeRenCe InFoRMAtIon

SpECiAl REquEStSPHA is committed to providing support for persons with disabilities in accordance with the Americans with Disabilities Act (ADA). If you require ADA accommodations, please indicate this on your registration form.

DiEtARy REquEStSIf you have specific dietary requests, please indicate this on your registration form. This will allow us to have meals arranged prior to your arrival.

HotEl ACCoMMoDAtionSKeystone Resort & Conference Center1200 County Road 8 | Keystone, Co 80435 (800) 258-0437 | keystoneresort.com

Keystone Resort & Conference Center, a member of Preferred Hotels® & Resorts Worldwide and Associated Luxury Hotels Incorporated (ALHI), offers exceptional accommodations with elegant, mountain-style décor. Most rooms have balconies which, based on availability, may be requested at time of check-in. This popular hotel is located adjacent to the lake and is approximately 1.5 miles from the base of Dercum Mountain. The village offers a variety of shopping, dining, après-ski, and more.

Hotel accommodations have been reserved exclusively for attendees of the PHA 11th Annual Conference & Exhibits at a special discounted rate of $165 single/double occupancy per night. This rate does not include the 5.9% Colorado state tax and 5.775% Keystone city tax per night. One full room night’s deposit is required when booking. Cancellation outside 30 days of arrival is subject to a $30 processing fee per reservation. Cancellations made within 30 days of arrival are subject to forfeiture of the room deposit. No-shows, late arrivals, and early departures are charged the entire amount for the reserved stay.

Please contact the Keystone Resort & Conference Center directly to make your reservations. Use the discount code CF5PHA and call (800) 258-0437 to reserve your room. Make sure you mention that you are attending the Physician Hospitals of America Conference to receive the discounted group rate. This rate will be honored through Friday, August 19, 2011. After this date, reservations will be accepted based on space and rate availability.

AiRpoRt infoRMAtionThe Denver International Airport (DIA) is 90 miles east of Keystone via Interstate 70. DIA is a nonstop destination for more than 21 national and international carriers. For more information, visit flydenver.com.

CAR REntAl/tRAnSpoRtAtionPHA has secured a discounted rate for car rentals at Hertz. To reserve your rental at our special rate, provide the discount code CV#022Q4994 to your corporate travel department or travel agent. Individuals may also reserve online at hertz.com or by calling Hertz directly at (800) 654-2240. Remember to reference the PHA discount code when booking. At the time of reservation, the discounted rates will be compared automatically to other Hertz rates, and you will be quoted the best comparable rate available.

Shuttle service is available to and from the airport via Colorado Mountain Express. The cost is $50 per person each way for a shared ride service. A $2 fuel surcharge will be added to all transfers. Shuttle service can be scheduled when you reserve your room at the hotel. Mention the special code PHA. If you need to cancel your ride on Colorado Mountain Express, please do so at least 24 hours prior to your scheduled shuttle time.

EXECutiVE offiCERSpresidentMichael E. Russell, ii, MDtexas Spine & Joint hospital tyler, tX

president Electpaul KerensSenior executive officer Kansas City orthopaedic Institute, llC leawood, KS

immediate past presidentBrett GosneyChief executive officer Animas Surgical hospital durango, Co

Secretary/treasurerR. Blake Curd, MDSioux Falls Surgical hospital/ Surgical Management Professionals Sioux Falls, Sd

DiRECtoRSDavid C. AyersChief executive officer nueterra healthcare leawood, KS

thomas V. Bertuccini, MD, fACS, MBAMedical director lafayette Surgical Specialty hospital lafayette, lA

Sam Chacon, MD Sierra Surgery hospital Carson City, nV

John W. Dietz, Jr., MDChairman, Board of ManagersIndiana orthopaedic hospitalIndianapolis, In

Karen A. fiducia, fACHEPresident uSMd hospital division Irving, tX

James Grantexecutive Vice President national Surgical hospitals Chicago, Il

to RESERVE youR RooMCall Keystone Resort & Conference Center at (800) 258-0437

Mention discount code Cf5pHA andPhysician Hospitals of America Conference

John R. Harvey, MDMedical director and Chief executive officer oklahoma heart hospital/oklahoma Cardiovascular Associatesoklahoma City, oK

Douglas V. JohnsonChief executive officerStanislaus Surgical hospitalModesto, CA

Milla perry JonesVice President, Government Relations united Surgical Partners International, Inc. Addison, tX

Michael lipomiPresident and Chief executive officer Surgical Management Professionals Sioux Falls, Sd

thomas MallonChief executive officer Regent Surgical healthWestchester, Il

Hooman Sedighi, MDPresidentGloBAlRehAB hospitals dallas, tX

HEADquARtERS StAffJohn Richardson executive director

Zoë fullerMembership/operations Manager

Brittany JohnsonRegistrar

Scott Becker, JD, CpAlegal CounselMcGuireWoods, llP

Amber Walsh, JDMcGuireWoods, llP

Jennifer larkin lukawskiWashington RepresentativeBGR Group/BGR Government Affairs, llC

Schedule of eventSWEDNESDAy, SEPTEMbER 215:00 – 7:00 pm ConfEREnCE REGiStRAtion 5:00 – 6:30 pm KEynotE SpEAKER: Janet lapp, phD, CSp, CpAE6:30 – 7:30 pm RECEption AnD SoCiAl HouR

WEDNESDAy

THURSDAy, SEPTEMbER 22 THURSDAy

4:30 – 7:00 pm nEtWoRKinG RECEption in tHE EXHiBit HAll

tRACK 1: SuStAininG pERfoRMAnCE AnD GRoWtH

tRACK 2: BillinG, CoDinG, AnD finAnCE

tRACK 3: CliniCAl/pAtiEnt SAfEty

tRACK 4: lAW, politiCS, AnD tHE pRESS

8:50 – 9:40 am

9:45 – 10:35 am

10:40 – 11:30 am

11:35 am – 12:25 pm

2:45 – 3:35 pm

Medical Marketing Today: How to Attract Referrals in the “Tradigital” Marketing Worldnathan Bellah, leveltwoevan Meeks, leveltwo

Know Your (Payor) Contracts: It’s Not Just About the Rate PageRobyn Finnegan, university General health Systems

Enhancing Patient Safety Through Team CommunicationJune leigh, CnA healthpro

HIPAA Health Information Technology for Economic and Clinical Health (HITECH) ActPat McAnany, nueterra healthcare

How to Successfully Establish a Hospitalist ProgramMark Kennedy, eagle hospital Physicians

The Hidden Opportunities of Health Care Reform: Self-Pay Collection and Revenue Recoverytom Gill, deborah lelinkski, and Pat Murphy, ontario Systems

Case Management, Resource Utilization, and RACsBrenda Keeling, Patient Response, Inc.

Media Training 101Scott Christiansen, CCo healthcare Partners

The Perfect Storm Is About to Hit the Revenue CycleRob Brochert, BPA-Consulting

Utilization of Revenue Cycle and Patient Billing Information for Strategic Decision-Making and New Service Line DevelopmentRusty Shelton, Aargon

To Call or Not to Call…That Is the Question: How Effective Patient Communications Can Impact Your Patients’ Health and Your Bottom LinetJ Bauer, televox

The New Audit Landscape: MICs, MACs, RACs, and the Impact on Physician-Owned HospitalsAndrew Wachler, Wachler & Associates PC

Seven Steps to a Successful TurnaroundRaji Kumar, dallas Medical Center

Outsourcing Back Office Servicesthomas Jacobs, MedhQt

Success and Recognition Through Compliance with Federal Regulations and Joint Commission Standardsdonna Rossa, BSn, RnCnA, CPhQ, MBA, Phd, and Peter Rossa, BSn, Rn, CPhQ, MA, MS, Phd

Key Legal Developments Facing HospitalsScott Becker, McGuireWoods, llP

Implications of Publicly Reported Measures in an Era of Value-Based Purchasing: Are Physician-Owned Hospitals Ready?Courtney Staloch, oakleaf Surgical hospital

Building a Bridge to Health Care Payments: How Banks and Providers Work Together to Prepare for the FutureStuart hanson, healthcare Solutions at Fifth third Bank

Learning from a Crisis: Key Steps to Limit RiskPamela Popp, Arthur J. Gallagher & Co.

General Anti-Kickback Selling Shares at Fair Market Value Entering in Leases/Contracts with Physicians in Appropriate Ways Amber McGraw Walsh, McGuireWoods, llP

Value of Group Purchasing in Physician-Owned Hospitalseleanor Waddell, ProvistaJon Crow, Sioux Falls Surgical hospital

Growing Your Bottom Line and Market Share Through Exceptional, Patient-Centered Revenue Cycle ProcessingBobette M. Gustafson, Gustafson & Associates, Inc.

Clinical Documentation Integrity Programs and Your Hospital: How You Are Being Profiled and Financially Impacted by Lack of Appropriate Documentation and Capture of Medical NecessityBetty Bibbins, docuComp, llC

Accountable Care Organization Updateelias n. Matsakis, holland & Knight

1:50 – 2:40 pm

8:50 am – 4:30 pm ConfEREnCE SESSionS

12:25 – 1:50 pm lunCH in tHE EXHiBit HAll

3:40 – 4:30 pm Addressing Challenges and Implementing Turnaround Strategies in Financially Distressed HospitalsMichael lane, navigant Capital Consulting

Health Care Bad Debt Sales as a Means to Improving Your Bottom LineAnurag Sett, orion Payment Systems

Improving Quality and Increasing Volumes Through Employee-Directed CareMolly Sandvig, Joint Replacement hospitals of AmericaKenneth erickson, Joint Replacement hospitals of America

Expansion of Emerging Services Allowed Under the Affordable Health Care Acttoby hamilton and Randy Park, emerys

8:15 – 8:20 am president’s Welcome Michael E. Russell, II, MD, President, Physician Hospitals of America

8:20 – 8:25 am program overview and Announcements John R. Harvey, MD, Annual Conference Co-Chair

Paul Kerens, President Elect, Annual Conference Co-Chair John Richardson, Executive Director, Physician Hospitals of America

8:25 – 8:45 am Modern physician: third Annual physician Entrepreneur of the year Award and presentation

David burda, Editor, modern Physician

7:00 – 9:00 am ConfEREnCE REGiStRAtion 7:15 – 8:15 am ContinEntAl BREAKfASt 8:15 – 8:45 am GEnERAl SESSion

FRIDAy, SEPTEMbER 23

7:00 – 8:00 am ConfEREnCE REGiStRAtion 7:00 – 8:00 am ContinEntAl BREAKfASt 7:00 – 8:00 am EXHiBit HAll opEn 8:00 – 10:00 am GEnERAl SESSion 8:00 – 8:10 am program Announcements

8:10 – 8:30 am Member Business Meeting

FRIDAy

11:45 am – 1:00 pm lunCH in tHE EXHiBit HAll 1:00 – 4:15 pm ConfEREnCE SESSionS

tRACK 1: futuRE DEVElopMEnt ConVERSion

1:00 – 1:45 pm

1:50 – 2:35 pm

Physician Relationships: From Idea to Ink to ImplementationKaren hartman, Corazon, Inc.Susan heck, Corazon, Inc.

The “Work-Arounds” Revisited: Reconsideration of the Expectations to the PPACA’s Physician Ownership Prohibitionslorin Patterson, Partner, Reed Smith, llC

2:40 – 3:25 pm Given the Tumultuous Environment, Why Now Is a Great Time to Develop a HospitalJohn A. Marasco, Marasco & Associates, Stephanie terry, nueterra healthcare

6:30 – 10:00 pm BluE JEAnS AnD BBq At tHE KEyStonE StABlES

tRACK 2: BuSinESS opERAtionS tRACK 3: lEADERSHip AnD pHySiCiAn EnGAGEMEnt

Clinical Integration: Air Traffic Control for the Electronic Medical RecordPaul Weygandtl, J. A. thomas & Associates

Trends in Access Managementdeborah lelinski, ontario Systems

Responding to Quality and Cost Pressures in the Health Care Marketplace: How Physician-Owned Hospitals Can Establish and Communicate Their Value to the Payer and Patient CommunitiesIsabella Sledge, tides Medical, llC

Leadership CarouselCandance Grantham, Cook Children’s hospital northeast/nueterra healthcare

Impacting Profitability at Your Physician-Owned HospitalReed Martin, Surgical Management Professionals

How to Align Anesthesia, Perioperative, and Surgical Staff to Maximize OR Performancetimothy dowd, Md, Managing Partner, north American Partners in Anesthesia (nAPA)

3:30 – 4:15 pm Converting an ASC to a Surgical Hospitallouise Barker, nueterra healthcaredave Bono, nueterra healthcareMatt dennis, nueterra healthcare

Cost Containment Strategies for the Physician-Owned HospitalBarry denny, expense Management network, Inc.

Building Physician and Employee Engagement to Foster Patient Satisfaction and LoyaltyChris dustin, hR Solutions Inc.

JANET LAPP, PHD, CSP, CPAEDr. Janet Lapp issues a clarion call for hope. For 25 years, she has established a global reputation for turning problems into opportunities. With boundless energy, enthusiasm that refuses to be curbed, and the can-do message she imparts on audiences to create change in their lives, Dr. Lapp is a singular inspirational sensation. both a registered nurse and a clinical

psychologist, she is best known for her success guiding individuals, groups, and corporate teams to moving faster and further than they thought possible. She is an adventurer and an athlete who has competed internationally. Author of three books: Dancing with Tigers, Plant your Feet Firmly in Mid-Air, and Positive Spin, she is also the creator and host of the award-winning CbS series Keep Well.

SCOTT GOTTLIEb, MD Dr. Scott Gottlieb is a practicing physician and Resident Fellow at the American Enterprise Institute, a nonpartisan, not-for-profit institution dedicated to research and education on issues of government, politics, and economics. A leading expert in health policy, Dr. Gottlieb’s work focuses on providing insights into the economic, regulatory, and technological forces driving the transformation of healthcare today. Dr. Gottlieb is a regular

contributor to The Wall Street Journal, and has held editorial positions on the british Medical Journal and the Journal of the American Medical Association. He appears regularly as a guest commentator on the cable financial news channel CNbC. He serves as a board member to several life science companies and is a venture partner at the venture capital firm New Enterprise Associates and a health policy adviser to Arcoda Capital, a healthcare investment firm.

KEyNOTE SPEAKERS

Note: All sessions, speakers, and times subject to change

8:30 – 9:15 am Healthcare and politics: pHA update Jennifer Larkin Lukawski, BGR Group, Washington Representative for

Physician Hospitals of America John Richardson, Executive Director, Physician Hospitals of America

9:15 – 10:00 am Delivering High-quality Healthcare: A panel Discussion Leslie Fossey, Marketing Director, Consultant Patty Riskind, Senior Vice President of Medical Services, Press Ganey

Associates, Inc.

10:00 – 10:30 am nEtWoRKinG BREAK/EXHiBit HAll opEn

10:30 – 11:45 am KEynotE SpEAKER: Scott Gottlieb, MD

conference activitieS

ReGIStRAtIon InFoRMAtIon

GROUP REGISTRATION DISCOUNT PhA offers a discount to organizations sending more than one attendee to the annual conference. to be eligible for the discount, all registrants must be employed by the same organization and all registrations must be received at one time, from the same address, and under one payment. employees from a second location are not eligible.Contact PhA for more information.

CONFERENCE GUEST POLICythe guest category is reserved for spouses/guests who are not involved in the physician-owned hospital industry. For $250, guests can attend all dining functions and visit the exhibit hall (excludes Blue Jeans and BBQ; the guest fee for this event is $100). Guests cannot attend educational sessions and are ineligible for continuing education credits. A fully-registered conference attendee must accompany a guest to be allowed admission.

AddIt IonAl ACtIV It IeS oFFeRed At the KeyStone ReSoRt

bICyCLING Enjoy the great bike paths that travel throughout the county. Peddle around Lake Dillon or ride around Keystone Village. No reservations are required. Rentals (hybrid and single-suspension bikes) are available at the Keystone Adventure Center in Lakeside Village. Full-suspension bikes for use on Dercum Mountain are available only at Mountain bike Headquarters in River Run.

bOATING ON KEySTONE LAKE Cruise around on the Keystone Village Lake with friends and family. Reservations are not required. Rentals are available at the Keystone Adventure Center.

KEySTONE FITNESS CENTER & SPAThe spa’s treatments combine organic products, indigenous ingredients, and rituals of massage, baths, warmth, and relaxation. Its therapists are dedicated to providing you with a unique spa experience that will soothe your muscles, heighten your senses, and re-energize your feeling of health and well-being. Keystone’s new spa features 100 percent wind power, eco-friendly staff uniforms, and natural light. Products are certified by European Organic standards—the most stringent standard in the industry. For more information, contact the spa at (970) 746-4118.

GUIDED HIKES Enjoy an easy, guided walk through Keystone’s Snake River Valley while learning about Rocky Mountain plants, animals, and history. Remember to pack a comfortable pair of walking shoes and your camera.

STARQUEST STAR GAzINGJoin the Keystone Science School as they present the Rocky Mountain skies as you’ve never seen them before! Enjoy an evening with the stars using their new, state-of-the-art observatory, high-powered telescope, and astronomy lab. All ages are welcome.

GPS ADVENTURETake part in a modern-day treasure hunt! Pinpoint a hidden “treasure” by entering pre-determined latitude and longitude waypoints into a Garmin eTrex Global Positioning System (GPS) receiver, and then use it to find up to three hidden caches along Keystone’s hiking and biking trails.

MINE TOURExplore the original workings of a historic mine as you feel, hear, and smell what it was like to be a Colorado miner more than 100 years ago! The authentic mine tour is located in nearby breckenridge.

FLy FISHINGCountless streams, ponds, lakes, rivers, and pocket water surround the community of Keystone. Cast your fly line to eager trout in the Snake River, blue River, Colorado River, and crystalline lakes. you’ll soon be hooked on fly fishing if you’ve never experienced the thrill and meditative qualities of fishing in the high-country.

TENNISWith more than 20 years of tennis resort management, the Keystone Tennis Center has carefully designed their tennis programs for your convenience. Call (970) 496-4220 for court times, private lessons, and clinics.

PLAy AND SAVE WITH KEySTONE’S ADVENTURE GAME New for 2011! Collect stamps at different locations throughout the resort and redeem for fun prizes. Keystone’s Adventure Game includes discounts on dining and activities—a great way to explore Keystone’s fun activities and award-winning dining.

MOUNTAIN CONCIERGEThe Mountain Concierge can book most activities. For reservations and additional information, call (800) 354-4FUN (4386). Note that costs associated with the activities are not included in hotel accommodations or in conference registration fees.

Put on your jeans and boots and join us Friday evening for an authentic barn Dance and bbQ at the Keystone Stables! Enjoy live Country Western entertainment (DJ and line dance instruction), horseshoes, “steer roping,” and a great barbecue dinner. Stroll on down or catch a complimentary shuttle to the Keystone Stables. This event is included in conference registration, and the guest fee for this event is $100.

Blue JeAnS And BBQ

FRIdAy, SePteMBeR 23 | 6 :30 – 10:00 PM

Enter this year’s golf tournament on the 71-par Hurdzan-Fry course at the Keystone Resort. With magnificent views of snow-capped peaks and wildlife, it’s easy to see why this is a golfing experience unlike any other. The par-35 front-nine is oriented around the path of the Snake River, and the par-36 back-nine winds through a lodgepole pine forest. Impressive elevation changes, variable bunkers, water hazards, and five sets of tees on each hole combine to challenge golfers of all abilities. The 16th hole features a 194-foot elevation drop from tee to green, and the scenic 18th hole offers 12 bunkers and spectacular views of Lake Dillon. The fee of $125 includes greens and cart fees with a shotgun start at 10:00 am.

GolF touRnAMent

WedneSdAy, SePteMBeR 21 | ShotGun StARt At 10:00 AM

REGISTRATION FORM11th ANNUAL CONFERENCE & ExHIBITSSEPTEMBER 21 – 23, 2011 | KEYSTONE RESORT | KEYSTONE, COLORADO

P AY M E N T I N F O R M AT I O N

q Enclosed is a check, payable to PHA. Check # ___________________________________________________________________________Mail completed registration form with check to Department 3109, Washington, DC 20042q I authorize PHA to charge my: q Visa q MasterCard q American Express q DiscoverFax completed registration form with credit card information to (202) 367-2173

Credit Card Number: _____________________________________________________________ Expiration Date: ______________________

Print Cardholder’s Name: _______________________________________ Signature: _____________________________________________Cancellation Policy: All cancellation requests must be made in writing by Friday, August 19, 2011. Cancellations made on or before August 19,

2011, will be eligible for a refund less a $100 processing fee. No refunds will be made for requests received after August 19, 2011.

Q U E S T I O N S ?Phone (202) 367-1173 | Fax (202) 367-2173 | Email registration@physicianhospitals.org | Web www.physicianhospitals.org

R E G I S T R AT I O N F E E S

On or Before Aug. 19

After Aug. 19Member

1st Person q $775 q $875

2nd Person q $750 q $850

3rd Person q $725 q $825

Non-Member

1st Person q $875 q $975

2nd Person q $850 q $950

3rd Person q $825 q $925

Guest registration q $250 q $250 includes Social event and reception

Blue Jeans and BBQ only q $100 q $100

Golf tournament q $125 q $125

TOTALAMOUNTENCLOSED ...............................$ ______________

if, due to a disability, you have special needs or any dietary restrictions, please let us know in the space provided, and we will do our best to accommodate you:

_________________________________________________________________________________________________________

C O N TA C T I N F O R M AT I O N

first name _________________________________ last name _____________________________________

degree _________________________________________ title _____________________________________

facility/company ___________________________________________________________________________

address ___________________________________________________________________________________

city _____________________________________________ State ___________________________________

ZiP/Postal code ________________________________ country ___________________________________

Phone ( ) __________________________________ fax ( )____________________________________

email _____________________________________________________________________________________

Guest first name _____________________________Guest last name _______________________________

(as you wish it to appear on your badge)

D E M O G R A P H I C I N F O R M AT I O N1.Genderq femaleq male

2.LevelofResponsibility(selectone)q agent/assistantq associateq directorq executive (c-Suite: ceo, cfo, President, etc.)q manager/Supervisorq Physicianq technicianq vice Presidentq other (specify): _______________________________

3.PrimaryWorkArea/Specialty(selectuptothree)q clinical resource managementq clinical Servicesq corporate office/health System headquartersq consultingq financeq human resourcesq information technologyq law/legal counselq materials managementq Pharmacyq Quality Servicesq Support Servicesq other (specify): _______________________________

4.NumberofEmployeesinOrganization(selectone)

q less than 25q 25-100q 100-200q more than 200

5.AnnualPurchasingBudget(selectone)q less than $1mq $1m to $5mq $5m to $10mq $10m to $50mq $50m to $100mq more than $100m

6.AreasofBuyingInfluence(selectuptothree)q administrationq consulting/legal Servicesq diagnostic imagingq emergencyq environmental Servicesq facility Planning/architecture/constructionq mailroom/Printing/Shippingq medical/Surgicalq operating roomq Physician clinicq technologyq other (specify): _______________________________

7.OrganizationType(selectone)q academic institutionq acute care facilityq assisted living facilityq consulting firmq Group Purchasing organizationq hospital/medical centerq law firmq managed care organizationq military/veterans’ affairs/Governmentq rehabilitationq vendorq other (specify): _______________________________

8.OrganizationSetting(selectone)q internationalq nationalq urbanq Suburbanq ruralq other (specify): _______________________________

ADDITIONALREGISTRANTS

FROMTHESAMEORGANIZATIONSHOULDMAkEACOPyOFTHIS

FORMANDCOMPLETETHEINFORMATION

INFULL.

Don’t miss the PHA 11th Annual Conference & Exhibits—the only conference dedicated to physician-owned hospitals!

PHySICIAn HoSPItAlS:lEADInG HEAltH CARE

Into tHE futuRE

Preliminary Program

SePtember 21-23, 2011 Keystone ResoRt

Keystone, ColoRado

Register Today• Discover the latest information to help you

provide the best patient care

• Explore tools and resources to improve clinical and business operations

• Earn CME and CEU credit

• Meet with others in the field through a range of networking opportunities

• Enjoy the sights and sounds of beautiful Keystone, Colorado

Keystonec o l o r a d o

Physician Hospitals of America

11th Annual Conference & Exhibits

Join us in

2025 M Street, nWSuite 800Washington, DC 20036(202) 367–1113