CHAIRMANS HIGHLIGHTS

A Building Year
I would characterize FY12 as a building year. This term is used in professional sports when new acquisitions have been made, players are young but developing, and theyre looking forward to have an outstanding year after this year of building. The Department of Internal Medicine has hired a substantial number of new faculty, particularly in the Divisions of Hematology and Oncology and Pulmonary, Critical Care and Sleep Medicine and we are looking forward to an outstanding few years. Some of the building highlights include: Establishment of an Outpatient Bone Marrow Transplant Facility- Shortly after his arrival at Saint Louis University, Dr. Friedrich Schuening, Division of Hematology and Oncology, announced his intent to establish an Outpatient Bone Marrow Transplant facility. The goal of this is to provide efficient care for patients undergoing bone marrow transplantation. Under his leadership, the bone marrow transplant program has already grown significantly under Dr. Schuening. In collaboration with Saint Louis University Hospital, an area in the West Pavilion was identified, construction commenced, and a new outpatient bone marrow transplant opened on December 3, 2012. Dr. Schuening has further divided the practice in his division into those physicians taking care of patients with hematological malignancies, on the one hand, and solid tumors on the other. Cardiology Initiatives- The electrophysiology practice has continued to grow under the leadership of Dr. Ali Mehdirad. The focus in this last year was on recruiting a cardiac surgeon to allow our cardiology programs to continue to grow. Dr. Richard Lee has successfully been recruited from Northwestern University in Chicago and joined the faculty at Saint Louis University in November 2012. He is working very closely with the cardiology faculty and, in fact, his office is located in among theirs in preparation for a very close collaborative relationship. Advanced Endoscopy- Dr. Louay Omran returned from a nearly 2 year leave of absence spent at the Medical University of South Carolina learning the techniques of advanced endoscopy. He returned in April 2012 to join Drs. Banke Agarwal and Jason Taylor, forming a very substantial unit to conduct endoscopic ultrasound and advanced ERCP procedures at Saint Louis University Hospital and other institutions in the area. Critical Care- As interim director, Dr. Ravi Nayak of the Division of Pulmonary, Critical Care and Sleep Medicine has successfully recruited 4 new faculty members, all board certified in Critical Care Medicine. This has allowed the formation of two ICU teams at Saint Louis University Hospital, each with its own attending. The young and energetic faculty members that he has recruited have reinvigorated the MICU teaching program and strengthened our patient care for critically ill patients.

CHAIRMANS HIGHLIGHTS
EPIC- In June 2012, Saint Louis University Hospital went live with its electronic health record. There is now a single instance of EPIC, both at Saint Louis University Hospital and in the practices of SLUCare. This was one of the most rapid implementations done by EPIC, but it appears to have been successful. We continue to work with Saint Louis University Hospital to optimize the use of EPIC, but, we have taken a major step forward in providing modern care for our patients admitted to Saint Louis University Hospital. Remaining Questions- We end the year with some questions still unanswered. One of them is the fate of a much discussed new ambulatory care center. During the last year, a very large tract of land immediately north of Saint Louis University Hospital was cleared in preparation for the possible construction of a new ambulatory care center. At the time of this writing, no plans have been finalized with regard to the exact location of the building, who will occupy it, or how it might be financed. Nonetheless, this initiative remains very important to the future of SLUCare and the University Medical Group. An item related to this is the question of partnerships between the University Medical Group and others. In the era of the Affordable Care Act, or Obamacare, there is great emphasis on risk sharing and the development of Accountable Care Organizations (ACOs), emphasizing the importance of partnerships between physicians and hospital and other care providers as well as third party payers. To assist us in doing this, Saint Louis University commissioned a report from the Navigant Group and the UMG leadership are in the process of implementing some of the recommendations of the Navigant report, at this stage to enhance revenue, but, the question of the appropriate partners for the University Medical Group (under the leadership of new CEO, Mr. Gary Van House) still remains open. With regard to teaching, faculty in the department of internal medicine have remained actively involved in the planned restructuring of our curriculum for medical students. The plan will be to shorten the first 2 years of education to allow students to commence their clinical education at an earlier stage. This will require some restructuring of the internal medicine clerkship, but also allowing the internal medicine clerkship split into an inpatient and ambulatory care block. In addition, students will be required to do some internal medicine training in their fourth year of education. Research- It remains a goal of the Department of Internal Medicine to recruit several new physician-scientists in the next year or two. Searches are underway in Endocrinology, Infectious Diseases, Allergy and Immunology, Pulmonary, Critical Care and Sleep Medicine and possibly Cardiology. Presidential Research Fund Awardees During FY12 Frederich G. Schuening, M.D. David Q. Wang, M.D., Ph.D. $25,000 $25,000

CHAIRMANS HIGHLIGHTS
Department of Internal Medicine Blue Ribbon Funding During FY12 Michael I. Rauchman, M.D. Departmental Clinical Activities MGMA AMBULATORY ENCOUNTERS BILLED FY 08, 09, 10, 11, 12 The figures below represent counts of patient/physician outpatient encounters as defined by the Medical Group Management Association (MGMA) guidelines.
PRACTICE LOCATION FY 08 YTD BILLED AMB ENCs 9,202 743 2,774 51,215 280 316 491 14,454 6,891 10,462 6,714 FY 09 YTD BILLED AMB ENCs 9,865 805 3,965 52,680 0 246 1,508 13,435 7,313 10,587 8,042 FY 10 YTD BILLED AMB ENCs 10,290 771 5,731 53,087 0 214 1,877 15,334 7,170 9,899 8,673 FY 11 YTD BILLED AMB ENCs 11,392 735 5,817 48,915 0 0 1,678 16,279 7,609 9,024 8,753 110,202 FY 12 YTD BILLED AMB ENCs 12,509 813 6,582 51,134 0 0 2,112 18,611 6,469 10,706 8,261 117,197

$55,000

CANCER CENTER CARDINAL GLENNON DES PERES DOB MIDWEST ENDOSCOPY OP CATH LABS SLEEP DISORDERS CENTER SLUH SNF/NF/CC/HOSPICE* UNIV CLUB TOWER OTHER

Grand Total 103,542 108,446 113,046 * SNF (Skilled Nursing Facility), NF (Nursing Facility), CC (Custodial Care), Hospice

Summary of the department's clinical financial performance fiscal years 2007 to 2012

FY 07 Net Operating Revenues Total Operating Expenses UMG Overhead Allocation Net Income (Loss) 32,379,303 28,836,060 4,310,267 (767,024)

FY 08 33,519,913 31,153,364 4,512,516 (2,145,967)

FY 09 35,769,587 32,441,083 4,495,035 (1,166,531)*

FY 10 36,762,637 32,545,897 4,794,015 (577,275)*

FY 11 38,037,426 34,911,305 4,555,669 (1,429,548)

FY 12 40,947,832 37,591,710 4,732,583 (1,376,461)

* The department had a budgeted net loss in fiscal years 2009 and 2010 of $1,758,942 and $1,561,607 respectively. The department's actual performance for these two fiscal years beat the clinical budget by nearly $700,000 in 2009 and $1,000,000 in 2010.

CHAIRMANS HIGHLIGHTS
Departmental Research Activities

FY 2012 TOTAL RESEARCH EXPENDITURES ($ in Thousands)

572 170 417 Cardiology / ECG Core Lab 747 Endocrinology 1,547 Gastroenterology and Hepatology Geriatric Medicine Infectious Diseases Nephrology Other Divisions

951 5,765

CHAIRMANS HIGHLIGHTS
Department of Internal Medicines Research Funding Fiscal Years 2007-2012
Fiscal Year 2012 DIVISION Cardiology Infectious Disease Geriatric Medicine Immunobiology Endocrinology Gastroenterology Other Divisions Total FEDERAL 383,452 5,505,320 797,414 Note 1 759,276 1,496,632 549,763 9,491,857 Fiscal Year 2010 DIVISION Cardiology Infectious Diseases Geriatric Medicine SLUCOR Gastroenterology Other Divisions Total FEDERAL 456,542 5,885,778 1,058,680 732,916 1,670,974 354,246 10,159,136 Fiscal Year 2008 DIVISION Cardiology Infectious Diseases Geriatric Medicine SLUCOR Gastroenterology Other Divisions Total FEDERAL 511,759 10,168,690 1,245,163 323,736 1,347,489 312,887 13,909,724 FOUNDATIONS 1,027 9,381 67,500 400,449 478,357 INDUSTRY 435,212 818,163 5,406 126,558 1,151,380 572,371 3,109,090 TOTAL 946,971 10,986,853 1,251,596 459,675 2,566,369 1,285,707 17,497,171 FOUNDATIONS 46,981 1,094,460 62,176 43,004 164,444 391,219 1,802,284 INDUSTRY 1,650,086 427,505 45,105 56,731 1,053,425 400,720 3,633,572 TOTAL 2,153,609 7,407,743 1,165,961 832,651 2,888,843 1,146,185 15,594,992 FOUNDATIONS 33,868 259,680 153,633 Note 1 23,083 191,865 662,129 INDUSTRY 751,894 751,456 41,058 Note 1 7,272 836,741 119,477 2,507,898 TOTAL 1,169,214 6,516,456 992,105 Note 1 766,548 2,356,456 861,105 12,661,884 Fiscal Year 2011 FEDERAL 305,106 6,323,632 816,032 1,173,308 Note 2 1,590,939 563,661 10,772,678 Fiscal Year 2009 FEDERAL 520,872 6,363,473 1,266,501 486,805 1,502,788 169,479 10,309,918 Fiscal Year 2007 FEDERAL 832,092 12,601,549 935,386 155,963 1,223,150 712,632 16,460,772 FOUNDATIONS (39,299) 11,139 153,822 40,000 18,527 129,780 313,969 INDUSTRY 1,421,822 505,758 42,770 940,454 742,179 788,477 4,441,460 TOTAL 2,214,615 13,118,446 1,131,978 1,136,417 1,983,856 1,630,889 21,216,201 FOUNDATIONS 23,922 5,000 30,094 8,511 91,483 310,081 469,091 INDUSTRY 731,035 945,225 27,313 145,285 1,550,868 530,893 3,930,619 TOTAL 1,275,829 7,313,698 1,323,908 640,601 3,145,139 1,010,453 14,709,628 FOUNDATIONS 42,646 515,919 74,395 182,696 Note 2 92,223 347,088 1,254,967 INDUSTRY 1,332,888 622,846 77,341 26,949 Note 2 812,906 196,582 3,069,512 TOTAL 1,680,640 7,462,397 967,768 1,382,953 Note 2 2,496,068 1,107,331 15,097,157

Notes: 1. Division of Immunobiology merged into Division of Infectious Diseases during fiscal year 2012. 2. Division of Endocrinology totals included in Other Divisions listing for fiscal years 2007 - 2011.

CHAIRMANS HIGHLIGHTS
Endowments and Overheads The department continues to have strong endowment revenues which are used to support its missions. We also contribute substantially to the institution through indirect costs and overheads associated with our clinical and research activities. Department of Internal Medicine Funded Endowments - FY 2012 Revenue ($ in Thousands)
Chairs Lectures Other

391

555

25

6,000 5,000 4,000 3,000 2,000 1,000 -

Institutional Overhead Contributed By Department of Internal Medicine ($ in Thousands)

UMG Grants Endowments, Clinical Trials & Donations

2006 2007 2008 2009 2010 2011 2012 Year

CHAIRMANS HIGHLIGHTS
Department of Internal Medicine Faculty, 2011-2012