Exhibit A EXAMPLE I: PERFORMANCE TARGETS. The Financial Target will affect 50% of the interest payable under the terms of the Bonds.

Transcription

1 Exhibit A EXAMPLE I: PERFORMANCE TARGETS There will be a Financial Target and three Non-Financial Targets, as described below. The Financial Target will affect 50% of the interest payable under the terms of the Bonds. The three Non-Financial Targets will affect the other 50%. In determining performance in terms of the Non-Financial targets, the three targets will have the relative weights set forth below. I. Financial Target: Net income equal to or greater than 3% of net revenue. II. Non-Financial Targets: A. Patient Satisfaction Targets (10% of Non-Financial Target Calculation) 1. Tool: Quarterly Gallup Patient Satisfaction scores: 2. Tools used: a. Inpatient survey b. Emergency department survey c. Outpatient testing & treatment survey (includes Lab, Diagnostic imaging, cath lab, rehab, and cardiac rehab) d. Outpatient surgery survey 3. Questions scored (for each of the 4 surveys): a. Would patient return to Hospital for services? b. Overall Satisfaction 4. Performance Levels: 1

2 Level A: 100% of interest allocable to the Patient Satisfaction Target will be paid currently if 10 or more Patient Satisfaction Indicators out of 16 are above 80th percentile, with others all above 50th percentile (5 out of 8 x 2 quarters = 10 out of 16) Level B: 50% of interest allocable to the Patient Satisfaction Target will be paid currently if 8 or more Patient Satisfaction Indicators out of 16 are above 80th percentile, with others all above 50th percentile Level C: 0% of interest allocable to the Patient Satisfaction Target will be paid currently if 7 or fewer out of 16 Patient Satisfaction indicators are above the 80th percentile B. Clinical Indicator Targets (60% of Non-Financial Target Calculation) 1. Tool: National Hospital Quality Measures 2. Indicators used: a. AMI Aspirin at arrival b. AMI Aspirin prescribed at discharge c. AMI ACE/ARB for LVSD d. AMI Beta Blocker at arrival e. AMI Beta Blocker prescribed at discharge 2

3 f. CHF ACEI for LVSD g. Pneumonia Pneumococcal vaccine h. Pneumonia Initial antibiotic received within 4 hours of hospital arrival i. Pneumonia Blood cultures performed before first antibiotic received in hospital 3. Public benchmarks published: 50th percentile, and 90th percentile 4. Additional derived benchmark: average of the 50th percentile performance and 90th percentile performance 5. Performance Levels: Level A: 100% of interest allocable to the Clinical Indicator Target will be paid currently if either: (i) 6 out of 9 measures above the 90th percentile and all others above the 50th percentile OR (ii) 7 out of 9 measures have improved compared to the prior two quarters Level B: 50% of interest allocable to the Clinical Indicator Target will be paid currently if either: 3

4 (i) 6 out of 9 measures above the average of the 50th percentile and 90th percentile and all others above the 50th percentile OR (ii) 6 out of 9 measures have improved compared to the prior two quarters Level C: 0% of interest allocable to the Clinical Indicator Target will be paid currently if performance is below Level B above C. Chart Completion Target (30% of Non-Financial Target Calculation) 1. Standards: a. History and physical completed, dictated or handwritten, within 24 hours of admission, or by time of operative or invasive procedure, whichever is earlier b. Operative reports dictated and completed within 24 hours of conclusion of procedure 2. Performance Levels: Level A: 100% of interest allocable to the Chart Completion Target will be paid currently if Barton achieves a 98% compliance level 4

5 Level B: 50% of interest allocable to the Chart Completion Target will be paid currently if Barton achieves a 95% compliance level Level C: 0% of interest allocable to the Chart Completion Target will be paid currently if performance is below Level B above Abbreviations used: ACEI Angiotensin-converting Enzyme (ACE) Inhibitors (lowers blood pressure) ARB Angiotensin II Receptor Blocker AMI CHF Acute myocardial infarction (heart attack) Congestive Heart Failure LVSD Left ventricular systolic dysfunction * * * * 5

6 EXAMPLE II: PERFORMANCE TARGETS Semiannual Quality and Patient Satisfaction Performance Participating Bonds Interest Payment Condition is met if at least 4 out of 5 criteria in both sets of categories are met: Quality and Safety 1. Achieve 100% compliance with patient marking, nurse questioning and time out final check procedures to eliminate wrong site/patient/procedure 2. Achieve 90% or higher compliance with giving written or oral physician order for antibiotic and giving of antibiotic to patient within one hour prior to surgical incision 3. Achieve 95% or higher compliance with taking of physical examinations and complete written histories and obtaining consent to surgery at least 24 hours prior to surgery 4. Hold at least six regularly scheduled performance improvement team meetings with attendance of 75% or more team members Patient Satisfaction 1. Achieve overall patient satisfaction rating of 93% or higher on the Press Ganey scale or equivalent 2. Achieve friendliness of physician rating of 95.5% or higher on the Press Ganey scale or equivalent 6

7 3. Achieve explanations prior to surgery rating of 95.0% or higher on the Press Ganey scale or equivalent 4. Achieve explanation of what was done rating of 93.5% or higher on the Press Ganey scale or equivalent 5. Achieve confidence in skill of surgeon rating of 97.4% or higher on the Press Ganey scale or equivalent 7