2010 Report to the Community

From the Board ChairI am pleased to present Commitment to Excellence, the 2010 Greenville Hospital System University Medical Center report to the community. Included in this report are facts and figures that highlight many important achievements of the last year.

Fiscal Year 2010 was filled with important milestones, and you will read about some of them in this report. For the Greenville Hospital System (GHS) Board of Trustees, the most significant of these milestones happened August 6, 2010, when our Board and the board of the University of South Carolina (USC) approved a formal agreement to move forward with plans for expansion of the USC School of Medicine–Greenville to a full four-year medical campus.

The historic nature of this partnership is understood and held with great reverence by all of my colleagues on the GHS Board. We know that serving as a Trustee of Greenville Hospital System, at any time, is an important responsibility and a high calling of service to our community. To be involved in a decision that promises to improve and enrich the health, quality of life, and economics of our community for generations to come is an honor and responsibility that we take very seriously.

It has been a great privilege to serve with the other Trustees of this impressive institution. Together, with a skilled executive team and a dedicated and compassionate workforce who are committed to excellence, we at GHS are living our vision to transform health care for the benefit of the people and communities we serve.

Frances D. EllisonChairGreenville Hospital System Board of Trustees

From the CEOThank you for taking time to review the Greenville Hospital System report to the community for FY 2010. In these pages we share highlights of key accomplishments related to our six Pillars of Excellence: People, Service, Quality, Growth, Finance and Academics. For every statistic and each achievement reported, there are many others that also are compelling. And behind every one of these successes is a team of people working together and living our mission to heal compassionately, teach innovatively and improve constantly.

One of our greatest strengths at GHS is a highly diverse and accomplished workforce (from physicians, nurses and other clinical professionals to support and administrative staff ) constantly working to address the needs of our patients and families. We emphasize interdisciplinary approaches to leadership and problem solving. In 2010, clinical and administrative leaders joined forces to react and respond to the shifting economic environment. As an example, the GHS Operations Council, established early in the year, is a leadership group consisting of physician department chairs, campus presidents and selected corporate leadership. This group was charged with working through the critical operational challenges of continuing our commitment to deliver high-quality care to a broad patient base while simultaneously addressing the need to reduce expenses in response to shifting volumes and declining revenue. By year’s end, we had reversed the early trend and ended FY 2010 exceeding our budgeted financial results.

Such interdisciplinary partnerships are being fostered at many levels within GHS. Today, physician and nurse leaders at the unit level work in tandem to ensure the highest standards of care and service. These partnerships serve as role models for collaboration in settings all across our health system.

A highly collaborative workforce is a tremendous asset at any time – and it is especially valuable when the environment is in flux. At GHS, we are well prepared for challenges and poised for change. We are transforming our health system to serve our many communities today and to be a vital health resource in the future.

Michael C. RiordanPresident and CEOGreenville Hospital System

Frances DeLoache EllisonChair

Margaret L. Jenkins

Harry A. Chapman Jr.Vice Chair

Rita McKinney

Jerry DempseySecretary

James C. Morton

Benjamin L. Allen Jr., M.D.

Thomas E. Simmons

R. Dennis Hennett

Benjamin B. Waters III

S. Hunter Howard Jr.

William M. Webster IV

GHS’ Pillars of Excellence guide

employees as to how to achieve our

vision and mission. By consistently

using best practices that are evidence-

based, GHS can build on its strong

foundation of employee commitment,

service excellence, and patient- and

family-centered care. In the case of

our People goal, sustaining a highly

committed workforce can boost success

across all six pillars.

Leadership Development RetreatsPart of GHS’ Commitment to Excellence is to develop excellent leaders committed to serving not only the community but also our physicians and employees. Presenting quarterly, evidence-based leadership practices helps the entire GHS team continue to improve quality of care and safety, consistency and accountability – and to enhance patient and employee satisfaction. Recognizing role models who excel in these practices is important as well. Evidence-based leadership training also supports our goal of developing a highly engaged and committed workforce.

Pillar: PeopleSustain strong employee commitment

Standards of BehaviorWith the unveiling of new Standards of Behavior came expectations that all team members will practice these standards so as to consistently deliver care and service to others as they would want for themselves. The standards are embedded in the word compassion. Creating an organizational culture where personal excellence is expected every day means that only those applicants who commit to the Standards of Behavior are considered for employment at GHS. Employee CommitmentA record 81 percent of employees completed the 2010 Employee Opinion Survey. Results placed GHS in the top 10 percent among healthcare facilities nationwide in employee engagement and commitment. Workforce commitment among physicians scored very high as well. Areas of strength included safety and quality, community contributions, being a good place to work and receive care, and being considered the region’s healthcare employer of choice.

The core of excellence centers on

delivering outstanding service. In

our ongoing quest to enhance patient

satisfaction, GHS team members

maintain an ever-present focus on

providing the best possible patient-

and family-centered care.

MD360®GHS recently opened its first MD360 urgent care facility, which provides convenient, extended-hour care each day. Staffed by board-certified doctors, MD360 offers temporary primary care, on-site testing, physical therapy, sports medicine and non-emergent care. It increases access to medical care and reduces unneeded trips to emergency rooms. The unique concept has proven so successful and patient satisfaction feedback is so high that another facility is slated to open soon.

Home HealthMarking 25 years of service and 31,494 annual visits, Home Health boasts low staff turnover and high performance for improved patient outcomes. The unit has earned Premier status for its efforts in reducing avoidable hospitalizations

Pillar: ServiceImprove patient satisfaction

and enhancing medication management for its 1,926 patients in Greenville and Pickens counties. With high quality and employee commitment marks, it is no wonder that Home Health’s patient satisfaction scores also run high – 97.9 out of 100!

Discharge Phone Calls A formal discharge call program began at GHS at the start of FY10. The program, dubbed the “best five minutes in health care” or the “final hug,” reaps many benefits. Besides fielding questions and reviewing discharge and medication instructions, nurses have found that their calls boost patient satisfaction and outcomes as well as reduce readmissions and complaints. An added bonus is improved service recovery (resolution of concerns that patients may raise about their care).

Pillar: QualityImprove clinical quality and safety

Hillcrest a Top PerformerAccording to Premier QUEST, Hillcrest Memorial Hospital is one of the highest performing hospitals in three areas: cost of care, evidence-based care and mortality. QUEST recognizes hospitals that demonstrate excellence in quality, efficiency, consistency and safety in patient care. In addition, the hospital ranked highest in South Carolina in pneumonia care with a score of 98, as reported by the Centers for Medicare & Medicaid Services.

Research shows that quality of

care improves when standardized,

evidence-based practices are provided

consistently across the board.

Achieving this goal is contingent on

strong collaboration and teamwork

among all staff.

Ranked Among the Nation’s BestFor the second year in a row, Greenville Memorial Hospital (GMH) was ranked among the nation’s top 50 hospitals in U.S. News’ 2010-11 guide to America’s Best Hospitals. GMH ranked high in three specialties: Diabetes & Endocrinology (#25), Gastroenterology (#39) and Heart & Heart Surgery (#45). It also ranked #5 for lowest rate of readmissions and received a Silver Achievement Award for Coronary Artery Disease/Congestive Heart Failure/Stroke.

Germ Warfare – Join the Battle!GHS recently announced the winning slogan of its hand hygiene campaign: Germ Warfare – Join the Battle! The campaign’s purpose is to educate staff, patients and visitors about the importance of good hand hygiene and to increase hand hygiene compliance among staff. Good hand hygiene is part of GHS’ Standards of Behavior and is crucial in preventing the spread of hospital-acquired infection and illness. At present, GHS is well ahead of its compliance goals.

A key goal of the system is to be the

area’s healthcare provider of choice.

Increasing patient and family access

to health and wellness services is an

important component in achieving

and maintaining this strategic objective.

Access to Primary Care PracticesA key factor in becoming the community provider of choice is improved access to primary care. This year, GHS acquired a primary care practice in Easley and one in Greer. Two new concepts in primary care also debuted: MD360 urgent care (staffed by board-certified physicians) and Heritage Pediatrics & Internal Medicine (doctors double-boarded in pediatrics and internal medicine). A recent study shows access has risen – 60 percent of GHS’ primary care offices can see new patients within one week!

Patient Referral and Transfer Center Integrated health care to communities from Greenville and well beyond is available through GHS’ Patient Referral and Transfer Center. The center was a response, in part, to feedback from referring doctors about difficulties in getting patients to GHS. This one-stop shop for rapid referrals of trauma, cardiac, stroke and other emergent care is accessible around

Pillar: GrowthAchieve budgeted net revenue

the clock and staffed by registered nurses. Customer satisfaction scores are high, with 5,000+ referrals logged in the first year of operation.

Partners Achieving Total Health (PATH)To provide increased access to services that promote health and wellness, GHS and the YMCA of Greenville formed a PATH partnership that includes low-cost membership to both GHS Life Center® Health & Conditioning Clubs and the four area Y’s. The innovative program focuses on community health, disease prevention and diagnosis, and healthy lifestyles. Since the initiative’s rollout in May, the Life Centers have tallied 1,168 PATH members visiting a total of 35,408 times.

Through responsible financial

stewardship, GHS strives to manage

revenues in line with operating

expenses. The resulting resources

help support high-quality patient

care, stellar academics and valuable

community outreach.

Supply Chain SavingsResponsible financial stewardship is more important than ever in these economic times. Cost-saving measures of $7 million were needed at GHS when it became clear in summer that supply cuts must occur. Initiatives focused on processes to reduce prices, achieve standardization, eliminate unneeded products, improve use, maximize existing contracts, and create and maintain a competitive environment. Thanks to quick teamwork across GHS, savings exceeded $7 million!

New Hernia Repair A GHS surgeon from The Hernia Center became first in the world to use an absorbable synthetic mesh to repair a hernia complicated by an infection. This unique product was developed with input from the doctor and his colleague. Previously, grafts from humans, pigs and cows typically were used to stem infection at prices upward of $20,000. Positive patient outcomes have eliminated such grafts for abdominal wall reconstruction at GHS, producing substantial cost savings.

Pillar: FinanceAchieve budgeted operating margin

UPLIFT Program Now implemented system-wide, UPLIFT (Use Portable Lifts in Facilitating Transfers) helps staff move, lift and transfer patients with less exertion. UPLIFT increases staff and patient safety, and it improves patient outcomes, with patient handling injuries plunging by 65 percent. Financial benefits also occur: Costs associated with staff injury have plummeted 75 percent! And in a three-year study at one GHS campus, the turnover rate for nurses was cut 48 percent once this equipment was installed.

Academics plays a major role in

transforming medical care. Strong

academic ties make it possible

for the hospital system to educate

much-needed health professionals,

advance clinical research and develop

innovative healthcare delivery.

Certified Registered Nurse Anesthetist TrainingGHS now is a satellite site for the Masters in Nurse Anesthesia program at the University of South Carolina School of Medicine. (Anyone hoping to become a much sought-after CRNA before had to move to Columbia or Charleston.) The first training class includes three GHS employees. The program uses long-distance learning so employees can “attend” class in Columbia. These students are able to make use of GHS’ simulation center to prepare for their clinical experience.

GHS Medical Experience AcademyTier I of the MedEx Academy launched over the summer with 12 students and a month-long slate of classes, hands-on activities, community service, research, mentoring and academic tutoring. This pioneering initiative to attract the brightest high school students interested in healthcare fields – clinical and non-clinical – is another way GHS is supporting workforce development efforts to minimize future health worker shortages. Tier II begins next year and will involve college students.

Pillar: Academics Strengthen academic affiliations

Medical School ExpansionGHS is hoping to expand the USC School of Medicine–Greenville to include first- and second-year medical students. (Third- and fourth-year students have trained here since 1991.) Both USC and GHS boards have agreed to pursue expansion plans to four years. An innovative curriculum will focus on evidence-based medicine, team care and comparative effectiveness research. GHS is busy preparing a self-study for the Liaison Committee for Medical Education, which is the next step in the approval process.

GHS Swamp Rabbit TrailTo help encourage healthy lifestyles and physical activity, GHS partnered with the Greenville County Recreation District to create the GHS Swamp Rabbit Trail. The 10-mile trail has been under construction since 2007, but the final section between Travelers Rest and Greenville was completed in 2010. To celebrate, the hospital system hosted the second annual GHS Swamp Rabbit 5K on May 7, which attracted nearly 4,000 people, making it the second largest 5K in the state!

SC Mission 2010GHS and other upstate healthcare providers joined forces to offer free medical, dental and vision care to 1,200+ low-income, uninsured South Carolinians. The inaugural two-day event, called SC Mission 2010, took place at Carolina First Center. More than 500 clinical and non-clinical volunteers donated 6,000 hours of service. The event was hugely successful in providing access to much-needed health services and will be repeated in 2011.

Power to Prevent DiabetesOne in 10 U.S. adults has diabetes – the ratio is even higher among African Americans. To slow this trend, GHS joined the S.C. Department of Health and Environmental Control’s Office of Minority Health to launch Power to Prevent, a 10-week education and awareness program to help people prevent, delay or control type 2 diabetes through healthy eating and exercise. The program helped 50 adults at risk or with diabetes lose an average of at least five percent of their weight, with one person shedding nearly 50 pounds and reversing her disease.

Ungirdled TruthsCommunity health education is a key part of GHS’ role as a good steward. To increase the number of people who can attend such events, the system undertook a novel step: commission a one-act play that spotlights women’s health issues. Employees make up the cast of Ungirdled Truths, and a panel discussion featuring physicians follows. The Gunter Theatre debut was a sellout at 400, garnering rave reviews, with more free performances being booked throughout the community.

Speed Dating to Find Dr. RightHaving a medical home where a doctor sees you regularly and can spot potential problems before they become life-threatening is critical. In 2010, GHS found a distinctive way to make accessing physicians easier for the community – speed dating! Prospective patients met individually with Greer-area internal medicine, pediatric and OB/GYN doctors to find the “right” physician for them and their family. Close to 50 people attended the session, with more planned for 2011.

Safe Kids® Upstate Celebrates 15 YearsAccidental childhood injury is the top killer of children under age 15 in the U.S. In South Carolina, a child dies every day from such injury. If families took the necessary precautions, 90 percent of these injuries could be avoided. In the last 15 years, targeted efforts by Safe Kids Upstate (led by GHS Children’s Hospital) have led to a 25 percent reduction in deaths and a 17 percent drop in accidental injuries in Greenville County. Motor vehicle deaths of children under 5 also have fallen by 43 percent.

GHS Gives Back: GHS is committed to being a positive force for the benefit of

the people and communities we are privileged to serve. Helping people take charge

of their health through awareness, prevention and education efforts offered by

the system – often in partnership with other area organizations – is an important

part of giving back to the community.

Christopher C. Wright, M.D.President

Bruce A. Snyder, M.D.Immediate Past President

GREENVILLE HOSPITAL SYSTEM AND THE ENDOWMENT FUND OF THE GREENVILLE HOSPITAL SYSTEM, INC. COMBINED STATEMENT OF REVENUES AND EXPENSESYear ended September 30, 2010 (In thousands) Net patient service revenues $1,314,003 Other revenue 32,060 Total revenues 1,346,063 Expenses: Salaries, wages, benefits and contracted labor 763,684 Supplies and other costs 455,448 Depreciation 77,809 Interest 17,676

Total expenses 1,314,617

Operating income 31,446

Non-operating Activities: Investment income 31,045

Revenues/expenses before capital contributions 62,491 Capital contributions 391

Excess revenues over expenses $62,882

Note: Does not include Greenville Health Corporation.

GREENVILLE HOSPITAL SYSTEM ANDTHE ENDOWMENT FUND OFTHE GREENVILLE HOSPITAL SYSTEM, INC.COMBINED BALANCE SHEETSeptember 30, 2010(In thousands)

AssetsCurrent Assets:Cash and cash equivalents $154,320 Patient accounts receivable(Less allowance for uncollectible accounts of $69,751) 192,513 Inventories of drugs and supplies 18,259 Other current assets 27,056 Current portion of assets with limited use 32,393 Total current assets 424,541 Assets with limited use 513,929 Less current portion (32,393) 481,536

Property, plant and equipment, net 704,999 Deferred charges and sundry 9,749

$1,620,825

Liabilities and Net AssetsCurrent Liabilities: Accounts payable $48,456 Accrued liabilities 130,602 Current portion of obligations under capital lease 113 Current portion of long-term debt 12,785

Total current liabilities 191,956

Long-term debt—less current portion 514,617 Obligations under capital lease–less current portion 3,749 Other long-term liabilities 93,555 Total liabilities 803,877 Net Assets: Unrestricted 620,416 Invested in capital assets–net of related financing 178,604 Restricted 17,928

Total net assets 816,948 $1,620,825

Note: Does not include Greenville Health Corporation.

Michael C. RiordanPresident and CEO

Susan J. BichelVP for Financial Services

and Chief Financial Officer

Joseph J. Blake Jr.VP for Legal Affairs and

General Counsel

H. Howell ClyborneVP for Community andGovernmental Affairs

Thomas W. Diller, M.D.VP for Clinical Effectiveness

and Quality

D. Douglas DormanVP for Human Resources and

Chief Human Resource Officer

Doran A. DunawayVP for Information Services

and Chief Information Officer

Malcolm W. IsleyVP for Strategic Services

William P. Marshall, M.D.Medical Director for GHSUniversity Medical Group

George F. Maynard IIIVP for Office of Institutional

Advancement

Gregory J. RusnakExecutive VP and

Chief Operating Officer

Angelo Sinopoli, M.D.Chief Medical Officer

Spence M. Taylor, M.D.Chief Academic Officer

Brenda J. Thames, Ed.D.VP for Academic Development

Suzanne K. White, R.N.VP for Patient Care Services/

Chief Nursing Officer andPresident of Greenville

Memorial Medical Campus

Jerry R. Youkey, M.D.VP for Medical Services andDean of Academic Services

Martin E. Lutz, M.D.Vice President

Medical Staff Officers

Senior Management

Tod N. TappertCorporate Chief of Staff

FacilitiesMedical Campuses 5Acute Care Hospitals 4Specialty Hospitals 3Long-term Care Facilities 2Wellness Centers 2 Outpatient Facilities 8Affiliated Practice Sites 130Licensed Beds 1,268Licensed Neonatal Intensive Care Bassinets 80

AcademicsMedical Students 57Resident Physicians 180 Residency Programs 7Fellowship Programs 7

The GHS TeamEmployees 9,778 Affiliated Medical Staff Physicians 1,264Employed Physicians (included in affiliated staff ) 542Registered Nurses 2,774Volunteers 1,200+

Procedures & SurgeriesRadiologic Procedures 526,831Outpatient Surgical Procedures 23,306Vascular Lab Procedures 19,060Electrophysiology Procedures 4,837Cardiac Catheterizations 6,904Cardiovascular Surgeries 3,367Inpatient Surgical Procedures (includes CV surgeries) 13,740Echocardiogram Lab Procedures 22,546

Clinical Care NumbersAir Transports 486Hospital Discharges 42,570Outpatient Visits (includes clinic and ER visits) 1,789,240Emergency Visits 164,883Medical Center Clinic Visits 114,192Home Health Visits 31,494Babies Delivered 5,167Clinical Trials 577

Statistics Snapshot

Greenville Hospital System uses guidelines set by the Catholic Health Association (CHA) and the American Hospital Association (AHA) that allow for equitable comparisons of community benefits among healthcare institutions. In recognizing the importance of community outreach in ensuring a high quality of life for all residents in the region, GHS offered support in a variety of ways during Fiscal Year 2010 (October 2009 through September 2010):

Benefits Recognized by CHA and AHA ...........................................................................................................$98.6 million

To help meet the medical needs of upstate citizens who have no healthcare coverage and cannot afford to pay for healthcare services, GHS provided more than $51.9 million in charity and government-sponsored health care (at cost) in Fiscal Year 2010.

Support to the Community and Community Health Partners, $46.7 million

Community benefit programs encompass community health services, education of health professionals, subsidized health services, research, and financial and in-kind contributions. In addition to offering health fairs, screenings and information sessions, GHS works with community groups and educational institutions to train healthcare workers and to ensure access to basic medical services for everyone.

Additional Benefits Recognized by AHA ...................................................................................................... $177.9 million

Medicare shortfall and bad debt (at cost) also are benefits that the hospital system provides. The Medicare shortfall represents $122.0 million of unpaid costs when reimbursement falls short of the actual cost of care. Bad debt, which totaled $55.9 million, occurs when patients are unwilling or unable to pay for services and do not seek charity care.

Total Quantifiable Community Benefit ...................................................................... $276.5 million

Community Contributions

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This report also can be found atghs.org 100704