FLOREDA AGENCY FOR HEALTH CARE NDMINESTRATION RICK SCOTT . . ELIZABETH DUDEK GOVERNOR Better Health Care for all Florrdrans SECRETARY May 29, 2012 Thomas M. Schlemmer Chief Financial Officer Tenet St Mary?s, lnc. 901 45th Street West Palm Beach, Florida 33407 RE: Certificate of Need (CON) Number 10055 2011 Condition Compliance Establish a Pediatric Open Heart Surgery Program Dear Mr. Schlemmer: Thank you for your calendar year 2011 condition compliance initial report received on May 25, 2012. Based on your submittal of the report, you are recognized as the authorized representative to act on behalf of the CON and license holder in this matter. Based on the information provided in your report it is the Agency?s determination that due to less than 12 months of licensed operation, as of December 31, 2011, no further action is needed regarding calendar year 2011. Please note that your report for calendar year 2012 is due to the Agency by April 1, 2013. Include in your report documentation of statements made and ?gures used. If you have any questions, please call me at (850) 412-4347. Since ly, . Ice, Ph Health Servic Facilities Consultant Certificate of Need Visit AHCA online at AHCA.MyFlorida.com 2727 Mahan Drive, 28 Tallahassee, Florida 32308 4? V?s tl If 90145th Street West Palm Beach, FL 33407 kg? HOSPI a Medical Center 551-340-5131 at St. Mary?s Medical Center May 23, 2012 Mr. James B. McLemore Health Services and Facilities MAY 2 5 2012 Consultant Supervisor Ola/Financial Anal Certi?cate of Need Program I, Vsis Of?ce State of Florida Me" Stop 28 Agency for Health Care Administration 2727 Mahan Drive Tallahassee, FL 32308 RE: CERTIFICATE OF NEED 10055 2011 COMPLIANCE REPORT PEDIATRIC OPEN HEART SURGERY PROGRAM TENET ST. INC. Dear Mr. McLemore: Enclosed please ?nd the FY 2011 Compliance Report for CON 10055 pursuant to Rule 5901.013, Florida Administrative Code. If you have any questions or need additional information, please contact our consultant Sarah Fitzgerald at (813) 286-4455 or me. Sincerely, WV Thomas M. Schlemmer Chief Financial Of?cer Enclosure cc Sarah Fitzgerald, Healthcare Financial Group, Inc. C. David Ross, V.P. Finance Tenet Florida Region Michael J. Glazer, Attorney COMPLIANCE REPORT CON 10055 FY 2011 Hospital: Tenet St. Mary?s, Inc. Project Description: Establish a pediatric open heart surgery program at St. Mary's Medical Center. The project involves 4,540 GSF of renovation at a renovation cost of $1 ,731 ,075. Condition: (1) The pediatric open heart surgery program will be located at St. Mary?s Medical Center, 901 45th Street, West Palm Beach, Florida; (2) Thirty percent of the combined pediatric open heart surgery and cardiac catheterization programs' total annual cases will be provided to Medicaid, Medicaid HMO, Health Care District and charity care patients; and (3) The applicant will enter into a partnership agreement with the University of Miami School of Medicine as specified in the application for the development and implementation of the program. 1. 2. The time period covered by the measure: January 1, 2011 to December 31, 2011. The measure for assessing compliance of the condition is identified and described: The measure for assessing compliance was to calculate the percentage of Medicaid, Medicaid HMO, Health Care District and charity care cases to the combined pediatric open heart surgery and pediatric cardiac catheterization programs' total annual cases. The way in which the conditions were evaluated by applying the measure: The hospital?s percentage of Medicaid, Medicaid HMO, Health Care District and charity care cases to the combined pediatric open heart surgery and pediatric cardiac catheterization programs' total annual cases was The pediatric open heart surgery program at St. Mary's Medical Center is a brand new program. The first pediatric open heart surgery was performed on December 7, 2011. This was the only pediatric open heart surgery case performed during 2011, and it was a commercial HMO case. As noted in the Compliance Report for CON #10054, there were no pediatric cardiac catheterizations performed at St. Mary's in 2011. The actual data sources used to generate the information on the conditions to be measured: The hospital?s internal records were used to determine the level of activity in the pediatric open heart surgery and pediatric cardiac catheterization programs. The source of the data for the measure: The data was derived from the patient accounting system. The patient's financial class was determined and verified upon admission and was tracked through our medical records and patient accounting system. The reasonableness of the measures and the confidence in the measure: As the condition is a percentage of total annual cases, I am confident that it is reasonable to use the actual number of cases by financial class for the measure. The person and position responsible for defining the measure and supplying the compliance report: Thomas M. Schlemmer, Chief Financial Officer Any other information necessary to determine compliance with conditions: None If applicable, the reason or reasons, with supporting data. why the Certificate of Need Holder was unable to meet the conditions set forth on the face of the Certificate of Need: It is too early to determine St. Mary's Medical Center's compliance with the pediatric cardiac catheterization and pediatric open heart surgery program's conditions. We anticipate filing a Condition Compliance Report with the Agency for Health Care Administration prior to April 1, 2013, which is expected to be more representative of the program's utilization. FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RICK SCOTT Better Health Care for all Floridians GOVERNOR April 1, 2o 13 ELIZABETH DUDEK SECRETARY Thomas M. Schlemmer Chief Financial Officer St. Mary?s Medical Center 901 45th Street West Palm Beach, Florida 33407 RE: Certificate of Need (CON) Number 10055 2012 Condition Compliance Establish a Pediatric Open Heart Surgery Program Dear Mr. Schlemmer: Thank you for your calendar year 2012 condition compliance report received on March 29, 2013. Based on your submittal of the report, you are recognized as the authorized representative to act on behalf of the CON and license holder in this matter. Based on the information provided in your report it is the Agency?s determination that your program complied with the combined Medicaid, Medicaid HMO, Health Care District and charity care condition on this certi?cate during calendar year 2012. Please note that your report for calendar year 2013 is due to the Agency by April 1, 2014. Include in your report documentation of statements made and ?gures used. If you have any questions, please call me at (850) 412-4346. Sincerely, James B. McLemore Health Services Facilities Consultant Supervisor Certi?cate of Need 2727 Mahan Drive, 28 Tallahassee. Florida 32308 Visit AHCA online at AHCA.MyF|orlda.com Palm Beach hildren?s Hospital at St. Mary?s Medical Center - - 3 901 45th Street West Palm Beach, FL 33407 ass Medical Center 561.840.6131 March 27, 2013 Mr. James B. McLemore Health Services and Facilities Supervisor Certi?cate of Need Program State of Florida Agency for Health Care Administration 2727 Mahan Drive Tallahassee, FL 32308 RECEIVED MAR 2 9 2013 RE: CERTIFICATE OF NEED 10055 2012 COMPLIANCE REPORT PEDIATRIC OPEN HEART SURGERY PROGRAM TENET ST. INC. Dear Mr. McLemore: Enclosed please ?nd the FY 2012 Compliance Report for CON 10055 pursuant to Rule 5901.013, Florida Administrative Code. If you have any questions or need additional information, please contact our consultant Sarah Fitzgerald at (813) 286-4455 or me. Sincer y, Thomas M. Schlemmer Chief Financial Of?cer Enclosure cc C. David Ross, Vice-President of Finance Sarah Fitzgerald, Consultant ST. MEDICAL CENTER COMPLIANCE TEST PEDIATRIC OPEN HEART SURGERY AND PEDIATRIC INPATIENT CARDIAC CATHETERIZATION CASES FOR CERTIFICATES OF NEED #10054 AND #10055 FOR THE YEAR ENDED DECEMBER 31, 2012 Medicaid Pediatric Open Heart Surgery Pediatric inpatient Cardiac Catheterization Cases Medicaid HMO Pediatric Open Heart Surgery Pediatric Inpatient Cardiac Catheterization Cases Palm Beach County Health Care District Pediatric Open Heart Surgery Pediatric Inpatient Cardiac Catheterizalion Cases Charity Pediatric Open Heart Surgery Pediatric inpatient Cardiac Catheterization Cases Total Medicaid. Medicaid HMO, Palm Beach County Health Care District, and Charity Total Pediatric Open Heart Surgery Cases Total Pediatric Inpatient Cardiac Catheterization Cases Total combined cases TOTAL CASES 19 19 AS A OF TOTAL CASES CON REQUIREMENT (UNDER) 42 27 26 53 79.25% 80.00% Per internai report "Pediatric Open Heart Surgery and Pediatric Inpatient Cardiac Catheterization Cases by Payor' for the year ended December 31, 2012 49.25% ST. MEDICAL CENTER PEDIATRIC OPEN HEART SURGERY AND PEDIATRIC INPATIENT CARDIAC CATHETERIZATION CASES BY PAYOR FOR CERTIFICATES OF NEED #10054 AND #10055 FOR THE YEAR ENDED DECEMBER 31, 2012 PEDIATRIC OPEN HEART SURGERY PAYOR TYPE TOTAL 7023 Charity 0 7023 Commercial 0 7023 Managed Care 6 7023 Medicaid 19 7023 Medicaid Managed Care 2 7023 Medicare 0 7023 Medicare Managed Care 0 7023 Other 0 7023 H00 0 7023 Tricare 0 7023 Uninsured 0 27 PEDIATRIC INPATIENT CARDIAC CATHETERIZATION PAYOR TYPE TOTAL 7111 Charity 0 7111 Commercial 0 7111 Managed Care 3 7111 Medicaid 19 7111 Medicaid Managed Care 2 7111 Medicare 0 7111 Medicare Managed Care 0 711 1 Other 1 711 1 HCD 711 1 Tricare 1 7111 Uninsured 26 COMPLIANCE REPORT CON 10055 FY 2012 Hospital: Tenet St. Mary?s, Inc. Proiect Description: Establish a pediatric open heart surgery program at St. Mary's Medical Center. The project involves 4,540 GSF of renovation at a renovation cost of $1,731,075. Condition: (1) The pediatric open heart surgery program will be located at St. Mary's Medical Center, 901 45th Street, West Palm Beach, Florida; (2) Thirty percent of the combined pediatric open heart surgery and cardiac catheterization programs' total annual cases will be provided to Medicaid, Medicaid HMO, Health Care District and charity care patients (Condition Modification iftyg/O6I/2009)\ 1. The tirrie period covered by the measure: January 1, 2012 to December 31, 2012. 5. The measure for assessing compliance of the condition is identified and described: The measure for assessing compliance was to calculate the percentage of Medicaid, Medicaid HMO, Palm Beach County Health Care District and Charity pediatric open heart surgery cases plus pediatric inpatient cardiac catheterization cases to total annual cases in the pediatric open heart surgery and pediatric inpatient cardiac catheterization programs. 3. The way in which the conditions were evaluated by applying the measure: The pediatric open heart surgery plus pediatric inpatient cardiac catheterization percentage of Medicaid, Medicaid HMO, Palm Beach County Health Care District and Charity cases to total cases was computed and compared to the applicable CON condition to determine if the condition was met. It appears that the condition was met, since Medicaid, Medicaid HMO, Palm Beach County Health Care District and Charity cases were 79.25% of total annual cases as compared to the condition of 30%. The ?Compliance Test" worksheet, along with the internal report "Pediatric Open Heart Surgery and Pediatric Inpatient Cardiac Catheterization Cases by Payor", is enclosed to provide supporting documentation. 4. The actual data sources used to generate the information on the conditions to be measured: The hospital's internal report ?Pediatric Open Heart Surgery and Pediatric Inpatient Cardiac Catheterization Cases by Payor? was used in the calculation. This report indicates the total number of cases by payor for both programs. A copy of this report is enclosed. 5. The source of the data for the measure: The data was derived from the patient accounting system. The patient?s financial class was determined and verified upon admission and was tracked through our medical records and patient accounting system. This system generated the reports noted above. 12. The reasonableness of the measures and the confidence in the measure: As the condition is a percentage of total annual cases, it is reasonable to use the actual number of cases by financial class for the measure. 13. The person and position responsible for defining the measure and sunplvind the compliance report: Thomas M. Schlemmer, Chief Financial Officer COMPLIANCE REPORT - continued CON 10055 FY 2012 8. Any other information necessary to determine compliance with conditions: None 11. Lapolicgble. the reason or reasons. with supportinq data. the Certi?cate of Need Holder was unable to meet the conditions set forth on the face of the Certi?cate of Need: NIA FLORIDA AGENCY FOR HEALTH CARE SCOTT . . ELIZABETH DUDEK GOVERNOR Better Health Care for all Floridians SECRETARY March 12, 2014 Thomas M. Schlemmer Chief Financial Officer St. Mary?s Medical Center 901 45th Street West Palm Beach, Florida 33407 RE: Certificate of Need (CON) Number 10055 2013 Condition Compliance Establish a Pediatric Open Heart Surgery Program Dear Mr. Schlemmer: Thank you for your calendar year 2013 condition compliance report received on March 11, 2014. Based on your submittal of the report, you are recognized as the authorized representative to act on behalf of the CON and license holder in this matter. Based on the information provided in your report it is the Agency?s determination that your program complied with the combined Medicaid, Medicaid HMO, Health Care District and charity care condition on this certificate during calendar year 2013. Please note that your report for calendar year 2014 is due to the Agency by April 1, 2015. Include in your report documentation of statements made and figures used. If you have any questions, please call me at (850) 412?4344. Sincerely, WW Jessica Hand Health Services 81, Facilities Consultant Certificate of Need 2727 Mahan Drive. 28 Tallahassee, Florida 32308 Visit AHCA online at AHCA.MyFIorida.com Palm Beach 901 45th Street West Palm Beach, FL 33407 West Faint Seam, Fioriria 561-844-6300 at St. Mary?s Medical Center March 5, 2014 Mr. James B. McLemore Health Services and Facilities MAR 1 1 2014 Consultant Supervisor 2 Certi?cate of Need Program State of Florida Agency for Health Care Administration 2727 Mahan Drive Tallahassee, lorida32308 RE: Certificate of Need 10055 2013 Compliance Report Pediatric Open Heart Surgery Program Tenet St. Mary?s, Inc. Dear Mr. McLemore: Enclosed please ?nd the FY 2013 Compliance Report for CON 10055 pursuant to Rule 5901.013, Florida Administrative Code. If you have any questions or need additional information, please contact our consultant Sarah Fitzgerald at (813) 286?4455 or me at (561) 882-6372. Sincerely, 4 Thomas M. Schlemmer Chief Financial Of?cer Enclosure Cc: Sarah Fitzgerald COMPLIANCE REPORT CON #10055 FY 2013 Hospital: Tenet St. Mary's, inc. Proiect Description: Establish a pediatric open heart surgery program at St. Mary?s Medical Center. The project involves 4,540 GSF of renovation at a renovation cost of $1,731,075. Condition: (1) The pediatric open heart surgery program will be located at St. Mary's Medical Center, 901 45th Street, West Palm Beach, Florida; (2) Thirty percent of the combined pediatric open heart surgery and cardiac catheterization programs' total annual cases will be provided to Medicaid, Medicaid HMO, Health Care District and charity care patients (Condition Modification 10/06/2009). 1 . 2. The time period covered by the measure: January 1, 2013 to December 31, 2013. The measure for assessing compliance of the condition is identified and described: The measure for assessing compliance was to calculate the percentage of Medicaid, Medicaid HMO, Palm Beach County Health Care District and Charity pediatric open heart surgery cases plus pediatric inpatient cardiac catheterization cases to total annual cases in the pediatric open heart surgery and pediatric inpatient cardiac catheterization programs. The way in which the conditions were evaluated by applyinqthe measure: The pediatric open heart surgery plus pediatric inpatient cardiac catheterization percentage of Medicaid, Medicaid HMO, Palm Beach County Health Care District and Charity cases to total cases was computed and compared to the applicable CON condition to determine if the condition was met. it appears that the condition was met, since Medicaid, Medicaid HMO, Palm Beach County Health Care District and Charity cases were 61.22% of total annual cases as compared to the condition of 30%. The ?Compliance Test" worksheet, along with the internal report "Pediatric Open Heart Surgery and Pediatric Inpatient Cardiac Catheterization Cases by Payor", is enclosed to provide supporting documentation. The actual data sources used to generate the information on the conditions to be measured: The hospital?s internal report ?Pediatric Open Heart Surgery and Pediatric Inpatient Cardiac Catheterization Cases by Payor" was used in the calculation. This report indicates the total number of cases by payor for both programs. A copy of this report is enclosed. The source of the data for the measure: The data was derived from the patient accounting system. The patient?s financial class was determined and verified upon admission and was tracked through our medical records and patient accounting system. This system generated the reports noted above. The reasonableness of the measures and the confidence in the measure: As the condition is a percentage of total annual cases, it is reasonable to use the actual number of cases by financial class for the measure. The person and position responsible for defining the measure and supplying the compliance report: Thomas M. Schiemmer, Chief Financial Officer COMPLIANCE REPORT - continued CON #10055 FY 2013 Any other information necessary to determine compliance with conditions: None If applicable, the reason or reasons, with supportinq datal why the Certificate of Need Holder was unabie to meet the conditions set forth on the face of the Certificate of Need: ST. MEDICAL CENTER COMPLIANCE TEST PEDIATRIC OPEN HEART SURGERY AND PEDIATRIC INPATIENT CARDIAC CATHETERIZATION CASES FOR CERTIFICATES OF NEED #10054 AND #10055 FOR THE YEAR ENDED DECEMBER 31, 2013 Medicaid Pediatric Open Heart Surgery Pediatric Inpatient Cardiac Catheterization Cases Medicaid HMO Pediatric Open Heart Surgery Pediatric Inpatient Cardiac Catheterization Cases Palm Beach County Health Care District Pediatric Open Heart Surgery Pediatric Inpatient Cardiac Catheterization Cases Charity Pediatric Open Heart Surgery Pediatric Inpatient Cardiac Catheterization Cases Total Medicaid, Medicaid HMO, Palm Beach County Health Care District, and Charity Total Pediatric Open Heart Surgery Cases Total Pediatric Inpatient Cardiac Catheterization Cases Total combined cases (8) TOTAL CASES 10 18 AS A OF TOTAL CASES CON REQUIREMENT 30 20 29 49 61.22% 30.00% Per internal report "Pediatric Open Heart Surgery and Pediatric Inpatient Cardiac Catheterization Cases by Payer" for the year ended December 31 . 2013 31.22% ST. MEDICAL CENTER PEDIATRIC OPEN HEART SURGERY AND PEDIATRIC INPATIENT CARDIAC CATHETERIZATION CASES BY PAYOR FOR CERTIFICATES 0F NEED #10054 AND #10055 FOR THE YEAR ENDED DECEMBER 31, 2013 PEDIATRIC OPEN HEART SURGERY PAYOR TYPE TOTAL 7023 Charity 0 7023 Commercial 0 7023 Managed Care 7 7023 Medicaid 10 7023 Medicaid Managed Care 2 7023 Medicare 0 7023 Medicare Managed Care 1 7023 Other 0 7023 HCD 7023 Tricare 0 7023 Uninsured 0 20 PEDIATRIC INPATIENT CARDIAC CATHETERIZATION PAYOR TYPE TOTAL 7111 Charity 0 7111 Commercial 0 7111 Managed Care 5 71 11 Medicaid 18 7111 Medicaid Managed Care 0 7111 Medicare 0 7111 Medicare Managed Care 0 7111 Other 0 7111 HCD 7111 Tricare 7111 Uninsured 6 29