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Pepco C&I Energy Savings ProgramFor

Washington Adventist HospitalJune 24, 2014

• Program Overview

• Incentives Available:

– Existing Building

– New Construction

• Application & Payment Process

• CHP

• Questions and Answers

Agenda

EmPOWER Maryland energy savings goals is to reduce electric energy by 15% by 2015 delivered via the power grid to Pepco and Delmarva Power customer facilities in Maryland.

EmPower

Incentives for Existing Building Projects - Overview

Equipment Upgrades

• Standard Incentives- Pre-determined measures and incentives – Light Fixtures & Controls– Packaged HVAC Units– Chillers– VFDs– Commercial Refrigeration & Kitchen Equipment– Specialized Controls

• Custom Projects• Incentives for equipment upgrades and systems not covered by

Standard Incentives may be eligible for 0.16 per kWh saved for a minimum of 25,000 annual kWh savings

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Lighting Fixtures & Controls

MR 16 Integral LED Lamp $25

PAR 20 Integral LED Lamp $20

PAR 38 and PAR 30 Integral LED Lamp $30

New or Retrofit LED Exit Sign $25

Recessed, Surface, Pendant, or Track Head LED Fixture $60

Parking Garage or Gas Station Canopy LED Fixture $250

Parking Lot / Area Pole-Mounted and Wallpacks LED fixtures

$150

LED Fixtures &

Lamps

HVAC, Chillers and VFDs

Prescriptive and Alternative incentives are available HVAC, Chillers & VFD’s • HVAC Incentives

– Packaged Equipment up to 63 tons– Dual enthalpy economizer controls– Water source heat pump units, and evaporative-cooled air conditioning

units– Ground source heat pump units (geothermal)– Packaged terminal heat pump units and air conditioning units

• Chiller Incentives

– Chillers up to 1000 tons• VFD Incentives

– 2 hp and larger motors controlled by VFDs in HVAC systems and process (non-HVAC) functions

Commercial Kitchen Equipment

• Incentives for new ENERGY STAR® qualified electric equipment for food preparation include:

– Hot Food Holding Cabinets - $200-$300 – Convection Ovens - $350– Combination Ovens - $1,000– Griddles - $250– Fat Fryers - $200– Steam Cookers - $ 750

Commercial Refrigeration Equipment

• Incentives for refrigeration equipment include:– Refrigeration and freezer equipment (ENERGY STAR®

qualified) - $75 to $500 per unit– Ice Machines (CEE Tier 1 & 2) - $50 to $250 per unit– ECM evaporative fan motor: display cooler and/or freezer -

$50– ECM evaporative fan motor: walk-in cooler and/or freezer -

$50

Specialized Controls

• Incentives for the use of specialized controls, which provide energy savings by preventing lighting or equipment from consuming electricity when not in use, include:

– “Smart” Power Strips - $15– Personal Occupancy Sensors - $30– Vending Machine Controls - $30 non refrigerated/

$75 refrigerated– Hotel HVAC/Receptacle Controls - $70/$80

Existing Building Program enhancement

Energy Savings Studies• Walk thru Assessments – 75% up to $1,000

– Can be used as a preliminary assessment prior to the Detailed Study

• Detailed Comprehensive Studies – 75% up to $20,000– Benchmarking required

Bonus incentive • The 10% BONUS INCENTIVE is applied to the prescriptive

measures– The second project must be started within 6 months of

completion of the first project – The bonus incentive may not exceed the cost of the smallest

qualifying projects

New Construction and Major

Renovation Projects - Overview

Program Offerings• Comprehensive Design Support (CDS)

– Multi-phase process starting in schematic stage includes: brainstorming, simulation, adding ECMs design.

– CDS offers technical support from program energy experts and incentives to owners/customers and their design teams.

• Modified Design Support

– Projects which have progressed beyond schematic stage, and also for projects <50,000 square feet participating in the LEED process.

• Technical Assistance

– Available for projects which do not participate in design support. Program energy experts will propose ECM which will meet program guidelines for incentives and aid with calculations.

Comprehensive Design Support

Comprehensive Design Support Incentives:

Phase I Brainstorming $1,000

Phase II Simulation analysis 1st 50,000 sf - $0.10 / square foot Additional sf $0.03 / square foot (refers to conditioned space)

Phase III Incorporate efficiency measures into design documents

up to $8,000(based on types of measures)

Phase IV Enhanced Commissioning

Up to $8,000

New Construction and Major

Renovation Projects - Overview

• New Equipment Incentives are available for all buildings (not just those going through Design Support or Technical Assistance) and include:

– Design-Based Lighting– VFDs – Packaged HVAC Units– Chillers– Commercial Water Heating– Commercial Kitchen /– Refrigeration Equipment– Specialized Controls– Custom Projects

Design-based Lighting

Incentive Criteria Incentive

Tier 1 90% to 80% of program ASHRAE 90.1-2010 baseline wattage

$0.40 per watt reduced

Tier 2 >80% to 70% of program ASHRAE 90.1-2010 baseline wattage

$0.80 per watt reduced

Continuous Building & Process

Performance Incentives

– O&M Training– Occupant Training

• Once the energy efficient equipment and controls are installed, the next step is to educate and train employees and occupants.

Program Process

Program Process

Preapproval • Required for all projects prior to purchase or install• Preapproval letter will be issued to applicant s and must be signed

and returned with expected completion date – Existing buildings have 6 months– New Construction have 1 year

• Project extensions are determine on a case by case basisProject completions• Customer is responsible for notify program once project is completed• Final invoices for labor and material are required • All projects are subject to inspection • Payment letter will be issued to payee and will receive check 6-8 for

the dated letter

Combined Heat & Power (CHP)

Reasons CHP is a Winner!

• More efficient production of electricity and heat

• Decreased facility operating costs

• Can provide power and heat during grid outages

• Reduced emissions and GHG Footprint

Six 65-kW Packaged CHP Units from

Capstone

PHI CHP Program Rules

• Incentives are available to any non-residential Pepco or Delmarva customer who pays into the EmPOWER MD Fund

• Any fuel (natural gas, propane, bio-gas, oil, etc.)• Any prime mover (gas turbines, steam turbines reciprocating

engines, fuel cells)• Any size (capacity rating)• At least 65% overall efficiency• All electricity generated must be used at host facility• 5-year warranty• TRC > 1.0• “Reasonably efficient” host facility• System must be operating by 12/31/16

PHI CHP Program Incentives

• Up to $2 million per project• Design = $75/kW• Installation = $175/kW• Production $0.07/kWh (for 18 months)• Example: 500 kW system running 7,500 FL hours/year

- Design: $75*500 = $37,500- Installation: $175*500 = $87,500- Production: $0.07*1.5*7,500*500 = $393,750- Total Incentive: $518,750 ($1,037.50/kW)

Paying For CHP System Installations

• Power Purchase Agreement (PPA)• Customers can Purchase, Lease, or Buy Output (via PPA)• Key parameters:

- Duration of the Agreement (e.g., 10, 15, 20 years)- Does it apply to both electricity and heat, or just electricity- Does it include or exclude fuel cost- Is(are) the payment rate(s) fully variable ($/kWh), or is

there also a fixed payment ($/month)- How is the variable component indexed- Are all O&M costs over the Agreement duration covered

Questions ?

The Benefits of Cogeneration:A Case Study of Upper Chesapeake Medical Center

May 6, 2014

Upper Chesapeake Medical Center

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• Located in Bel Air, Maryland, part of University of Maryland Medical System

• Contains a 200 bed state-of-the-art general medical, surgical hospital and medical complex including: Hospital Two medical office buildings (MOB) Pavilion I and II Parking garage Klein Ambulatory Care Center of Harford County Administrative offices Cancer Center

• Serves the residents of northeastern Maryland

University of Maryland Upper Chesapeake Medical CenterCampus Overview

Central Plant

CHP location

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Hospital Facility Challenges

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• Single point of failure in backup power system design One existing 1.5MW diesel generator

• Minimal to no upfront capital available for system upgrades Capital budgets favored other revenue generating investments Previous CHP capital budget requests denied

• Need for additional cooling capacity and backup power• Limited space to install new CHP system components• Increase electrical/steam/cooling/hot water availability

during utility outages and emergencies• Resources to oversee the design/construction/permitting and

operation and maintenance of the CHP system

Electrical Distribution Hurdles• Electrical service to the campus is delivered to a service

station via a pair of 33KV feeders: Fed to six (6) substations Three (3) of the six (6) substations feed the “healthcare” uses

• Cancer Center is serviced by a separate feeder• 1,500KW diesel generator insufficient to provide power to

greater than the critical care and a few other connected loads

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Solution Development• Worked with ESF team to evaluate system sizing,

location and options• Considered various options including:

Two (2) smaller cogeneration totaling 2MW Upsizing the absorption chiller Increasing loads on existing electrical buses

• Derived optimal solution after considering: Physical space Total system cost Seasonality of existing building loads Thermal loads balance with electrical production Noise mitigation to meet local ordinance db levels Environmental impacts BGE incentive requirements 6

UCMC CHP System Components• 2 MW Caterpillar Natural Gas Reciprocating Engine• 350 ton Broad Absorption Chiller• 500 ton Heat Rejection Cooling Tower• 2,245 lbs/hour Heat Recovery Steam Generator (HRSG) • Two heat rejection radiators• Two Plate and Frame Heat Exchangers• Power Monitoring Control System (PMCS)• Energy Management Control System (EMCS)

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Other Key CHP Major Components• Sump pump station• Switchboard/circuit breakers • Upgraded electrical breakers, panels and control systems• Field devices:

Natural Gas meters Heating & cooling system flow meters Valves, actuators, temperature, and pressure sensors

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2MW Natural Gas Fed Generator Set

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Chiller & HRSG Make Tri-Gen System350 Ton Absorption Chiller

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2,245 lbs/hour HRSG

System Layout

• The building houses: Generator HRSG Feed water pumps HT heat exchanger LT and HT radiators

• Other components located in or adjacent to the existing central plant include: Absorption chiller Cooling tower Electrical gear Control panels

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• The CHP is located within a single story, 705 sq ft building in existing mechanical pit

PPA Structure Highlights

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• Hospital buys all electricity generated by system from ESF• Byproduct of waste heat is “free” and used to calculate

“effective price of power”• Minimum monthly payments from hospital• Minimum performance guarantees by ESF• 20 year contract with fixed escalation, allows for budgeting

of utility expense• Operations and maintenance cost of system including all

rebuilds incorporated into cost for 20 years• Buy-out options for hospital to purchase system early• Hospital supplies natural gas – cost of this embedded into

economic analysis and savings

Rationale to Use PPA from Hospital Perspective• Use of Federal tax credits and depreciation cannot access

as non-profit hospital• Ability to lock in future electric rates• Access to funding source• Ability to have turnkey delivery of all aspects system

- Development - O&M- Permitting - Financing- Design - Incentive management- Construction

• Risk transference from hospital• Complexity of project coordination• Any cost overages borne by ESF

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Some CHP and PPA Considerations• Legal expense to negotiate PPA• Town/County willingness to abate certain personal property

tax• Balance sheet treatment by auditors• Potential of ongoing Title V compliance reporting costs• Preparation for potential DHHS standards

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Summary

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• CHP system a “home run” for UCMC• PPA structure facilitated delivery of vital infrastructure

which would not have otherwise received funding• Hospital able to operate during storm/prolonged outage

Improved reliability when combined with diesel generator (approximately 65% of hospital electrical load)

Serve as a vital community resource during emergencies

• Environmentally friendly solution 2.0MW system equivalent of taking 2,200 cars permanently off our

roads!

On-Site Power Solutions: The Benefits of Cogeneration

MDH2E Seminar

May 6, 2014

Click to edit Master title styleAgenda

Highlights of CHP at Case Study of Upper Chesapeake Medical Center

On-Site Power Technologies for Hospitals

Factors Making CHP an Attractive Option

Considerations When Evaluating a CHP Installation

Benefits of Turnkey Delivery of On-Site Power Systems

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Case Study At Upper Chesapeake Medical Center

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Highlights of CHP At Upper Chesapeake

Medical Center

Click to edit Master title styleESF Solution for UCMC

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2.0 MW reciprocating engine system– Generates electricity, steam, chilled water and hot water– Parallels the utility and provides baseload power

Client will purchase balance of electricity for normal operations from utility and when CHP is offline– Provides 45% of the existing electricity for the main interconnected loads– Supplies more than 60% of electricity with existing diesel generator – Qualified for over $1.5M in Empower Maryland

ESF to sell power to UCMC over 20 year term with buyout options

UCMC to save $9M+ over 20 year life cycle, net of buyout costs

Project operational in June 2014

Click to edit Master title styleUCMC Uses a PPA

Power Purchase Agreement (PPA) has private sector entity: – Owning system assets– Funding all project and life cycle costs– Managing all project risks– Selling electricity to hospital– Generating thermal capacity for heating / cooling– Supplying operations & maintenance and system rebuilds– Providing minimum performance guarantees– Transferring proven system to hospital at option points

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Click to edit Master title styleUCMC Project Savings Analysis

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$-

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Th

ou

sa

nd

s

Energy Savings Projections – 20 Year Analysis

Utility Baseline

PPA Model

On-Site Power Technologies for Hospitals

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Click to edit Master title styleKey On-Site Power Technologies

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Solar Photovoltaics

Combined Heat & Power (CHP) Systems

Biomass

Microturbines

District Energy/Microgrids

Click to edit Master title styleMost Relevant Technologies for Hospital Applications

Solar PV – Addresses peak demands (from noon-5pm) and peak pricing

Microturbines – Useful for smaller facilities where there is a limited use for the waste heat

CHP or CCHP – Using reciprocating engines or gas turbines– High “base load” demand for electricity

– Uses of waste heat for steam, hot water & chilled water

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Click to edit Master title styleSolar Photovoltaics

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Converts solar radiation into electricity

Helps offset peak energy demand charges (noon – 5pm)

Generates no pollution / fully renewable

Have improving economics:– Solar renewable energy credits

– 30% investment tax credit

– Declining panel pricing

Solar Array at FedEx Field Installed by Clark

Are installed on ground, rooftops, car ports & garages Less applicable in Maryland due to :

– Lower REC Value – Weather – Absence Utility Peak Pricing

Click to edit Master title styleMicroturbines

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Small combustion turbines which operate similarly to large CHP systems, but are typically constructed in modular units

Known for high uptime and reliability

Utilized to capture waste heat but more commonly used solely to produce electricity

Microturbine systems are proportionately more expensive (on a per kW basis) than reciprocating engines or gas turbines

John Muir Medical Center, Walnut Creek, CA

Click to edit Master title styleOverview of Combined Heat and Power (CHP)

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Use fossil fuel (typically natural gas) to simultaneously generate electricity and useful heat

Typically use reciprocating engine or gas turbine as prime mover

Capture useful heat for many purposes:

Reduce environmental footprint (CO2, NOX, SOX) of facility compared with using utility energy

Can be designed to run in “island mode” in event of grid failure, providing power, heating and cooling to facility

Provide back-up power generally to non-critical care needs of hospitals, complementing use of diesel generators

– Steam– Hot water

– Chilled Water– Deaeration

Click to edit Master title styleCHP Systems Are Very Efficient

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Click to edit Master title styleCHP Systems Can Be Tailor-Made

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Click to edit Master title styleCHP Sizing

Prime mover choice and sizing driven by the need to balance thermal and electric loads

Thermal capacity is typically the limiting factor

Tie in to existing CHW/HW/Steam and electrical systems

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Factors Making CHP Installation an Attractive

Option

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Click to edit Master title styleBenefits of CHP

Reliability: Additional source of primary and emergency generation for both electricity and heating/cooling

– Proven technology with thousands of applications globally

– Backup to diesel generators if prolonged outage or diesel failure

Community Service: Allows hospital to serve as a safe haven to the community during a disaster

Cost Savings: Given efficiency and “spark spread,” can often generate heat and power at a lower cost than traditional systems

Stability: Less volatile lifecycle costs of energy vs. unpredictability of the grid

Environmental: Significantly reduces environmental impact and pollution

Political: Reduces reliance on foreign oil and increases energy independence of U.S.

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Click to edit Master title styleExternal Factors Driving CHP Adoption

Historically-low natural gas prices

Favorable tax incentives and state financial support

National energy security and resilience post-Hurricane Sandy

U.S. Government/regulatory support and mandates

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Click to edit Master title styleAttractive “Spark Spread” Enhances Project Economics

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Differential Between Electricity and Natural Gas Pricing

Click to edit Master title styleHistorically Low Natural Gas Prices

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Increasing Capacity Suggests Lower Long-Term Pricing

0

5

10

15

20

25

30

35

$0

$2

$4

$6

$8

$10

$12

$14

$16

Tri

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n C

ub

ic F

ee

t

$ /

MM

Btu

Henry Hub Gas Prices Gas Production

Projected Gas Price

Projected US Gas Production

Source: Energy Information Administration

Click to edit Master title styleIncreasingly Severe Weather Patterns On The Rise

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Number of Events & Remediation Costs of Major Storms

Hurricane Sandy, Derecho, Snowpocalypse/Snowmageddon

Click to edit Master title styleSome Hospitals Faced Dire Circumstances…

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Experience During Hurricane Sandy

• Explosion at electrical substation causes Power Failure

• Back-up generators malfunctioned• Critical care services shut down• Evacuation of 300 patients

Post-Sandy Implementation

• Planning for a CHP system was underway before Hurricane Sandy

• Hospital to install a 10.5 MW CHP system with natural gas combustion and steam turbine generation

• Expected Completion: Summer 2016

NYU Langone Medical Center

Click to edit Master title style…While Other Hospitals Rode Out The Storm

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Danbury Hospital (CT)• 371 Bed Hospital• 4.5 MW Mercury™ 50 gas turbine

During Hurricane Sandy• Area lost power for several days• Facility continued operation without loss of

power and heat• Provided continued critical care

Greenwich Hospital (CT) • 175 Bed Hospital• (2) 1.25 MW Gas Reciprocating Engine

During Hurricane Sandy• Area around lost power for 7 days• Restarted in Island Mode within 5 Minutes• Continued operation of facilities• 156 Patients were provided care

Click to edit Master title styleRegulatory Drivers

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DHHS proposed rule (Federal Register Vol. 78 No. 249) would require hospitals to have alternate sources of energy to maintain temperatures to protect patient health and safety and for the safe and sanitary storage of provisions

President Obama signed Executive Order 13624, setting a national goal of deploying 40 GW of new, cost effective industrial CHP in the United States by the end of 2020

• New Jersey has set a CHP goal of 1,500 MW by 2020 with a grant program• Maryland has incentives for up to $2M per project (goal of 21.5MW)• New York City has a CHP goal of 800MW new capacity by 2030• California has set a goal of 6,500 MW by 2030 and an SGIP incentive program• Connecticut has a grant program worth $200/kW

Click to edit Master title styleFinancial Incentives Make it Attractive To Implement Now

Interest rates are at historical lows, reducing debt costs

Federal tax incentives are available– Investment Tax Credit (ITC) is equal to 10% of project cost (set to expire 12/31/2016)

– Accelerated depreciation (using 5 Year MACRS schedule) applied to qualifying energy costs

– Bonus Depreciation may be available through 2015 offering a 50% increase in Year 1 depreciation

Numerous State incentives exist to support CHP applications– EmPOWER Maryland $2M incentive

– California SGIP program

– North Carolina State tax credits

– New Jersey grant programs

– Connecticut grant programs

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Considerations When Evaluating a CHP Installation

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ConsiderationsWhen Evaluating a CHP Installation

Click to edit Master title styleFacility Considerations When Assessing CHP

Total base electrical load

Seasonal needs for cooling, hot water and steam

Centralized electrical and thermal distributions on campus

Location to place system (square feet needed)

Funding source and “payback”

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Click to edit Master title styleCHP Project Evaluation Process

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Project Feasible?

Develop Project

Stop

YesBasic Project Analysis

1-2 weeks

Required:

• 12 mo. utility data• Single lines

Full Feasibility Analysis

6-8 weeks

Required:• Schematic Drawings• Client Credit Analysis• Energy Simulations

Requalify Project

▪ Cost Analysis

Stop

No

Yes

No

Project Feasible?

Iterative project evaluation process can determine project feasibility, while minimizing cost

First steps include general projections and fatal flaw analysis, then move on to in-depth engineering study and design

Click to edit Master title styleProject Obstacles Relative to Other Capital Demands

ROI or Payback may be insufficient

Project complexity may limit ability to undertake given demands on facility staff

Competing uses of capital dollars may prevent approval, especially if other investments generate revenue

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Benefits of Turnkey Approach

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Benefits of Turnkey Approach

Click to edit Master title styleProject Involves Multiple Disciplines & Risks

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CHP Project

Construction Management

Environmental Permits

Utility Interface/ Interconnection

Finance

Design/Engineering

Incentive Applications

Operations & Maintenance

End-UserConstraints

Tax Benefits

Click to edit Master title styleHealthcare Operational Challenges

Hospital functioning under all conditions

Do no harm

Ongoing operational management responsibilities

Integration of new system

– Complexity

– Need to minimize shutdowns / system outages

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Click to edit Master title styleTurnkey Approach with ESF

FINANCELender

ESFClientDEVELOPMENT

PermitsUtilities

Deal Structure

TAX EQUITY

ON-GOING MANAGEMENT

Fuel SourceO&M 33

CONSTRUCTIONDesign/Engineering

Construction Management

Click to edit Master title styleTurnkey Approach Can Include Financing

Under a Power Purchase Agreement (PPA) structure, a 3rd party owns the system and sells power to a customer

Project risk is shifted from the facility to the PPA provider

Customer should have the opportunity to buy out the system at a Fair Market Value early in life-cycle

PPA arrangement allows public sector / non-profit organizations to access Federal and State tax incentives

Other incentives (e.g. Maryland CHP Incentive) can be rolled into PPA rate

Can be structured to remain off credit and potentially off balance sheet

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Click to edit Master title styleOther Benefits of Turnkey Approach

Frees capital for other uses (e.g., MRIs, staff, other infrastructure)

Balance sheet treatment should not affect debt capacity of hospital

Allows staff to focus on core business (you have day jobs!)

Project delivery risk transferred to an able third party

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Click to edit Master title styleSummary

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CHP system at UCMC will save hospital over $9 million over 20 years (system operational 30-35 years with regular maintenance)

Hospital able to serve community during disasters

UCMC able to avoid any upfront capital outlay for project through PPA structure– May choose to purchase system based on proven track record– Transferred performance, delivery, O&M and other risks– Facilities staff trained in operations and ready to take over system in future

Click to edit Master title styleProject a Great Example of Team Effort!!

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Maryland Hospitals for a Healthy Environment

Monthly News Roundup

IN THIS ISSUE:

GBMC 2

Medstar Franklin

Square Hospital 3

University of

Maryland Upper

Chesapeake Hospital

4

UMMC 5

Events/ Welcome

new MD H2E team

member

6

June • 2014

www.mdh2e.org

MD H2E and Maryland Hospitals chosen as

Environmental Leaders Environmental Leader included MD H2E as one of 104 industry experts sharing

valuable information regarding environmental, energy and sustainability

programs. The website offers online green business and corporate sustainability

news, and recently published the fourth edition of its Insider Knowledge Report.

To read more about the report, or download it from the EL website, click HERE.

MD H2E can be found on page 25.

MD Healthcare

Sustainability

Leadership

Meeting

JUNE 18TH

8 AM– 10 AM

MARYLAND

HOSPITAL

ASSOCIATION

RSVP to Barb

Colleran

Top 25 Award

Bon Secours Hospital System—

Baltimore

Emerald Partner for Change

Johns Hopkins Hospital

Levindale Hebrew Geriatric Center and

Hospital

Sinai Hospital of Baltimore

University of Maryland Medical Center

Greater Baltimore Medical Center

Champion for Change

Maryland Hospitals for a Healthy

Environment

Greening the OR

University of Maryland Medical Center

Greenhealth Partner for Change

MedStar Franklin Square Medical

Center

MedStar Good Samaritan Hospital

MedStar Harbor Hospital

MedStar Montgomery Medical Center

MedStar Union Memorial Hospital

Northwest Hospital

Kaiser Foundation Health Plan of the

Mid-Atlantic States

Mercury Free Award

MedStar Union Memorial Hospital

Congratulations to Maryland’s Practice

Greenhealth award winners!

MD H2E announces winners of the 2013

Trailblazer Awards

Congratulations to GBMC,

Medstar Franklin Square

Hospital, University of

Maryland Medical Center

and Upper Chesapeake

Medical Center for winning

the 2013 Trailblazer awards.

Read on for write-ups on the

great sustainability

programs these hospitals

implemented last year.

From L-R: Gene Corrado, Don Allik (Upper Chesapeake), Jeff Rivest (UMMC), Larry Strassner, Juan DeJesus

(Franklin Sq.), John Chesare (GBMC), Joan Plisko (MD H2E), Jeff Pargament (MHA)

June • 2014

Page 4 www.mdh2e.org

Maryland H2E News Roundup

University of Maryland Upper Chesapeake Medical Center (UCMC) is constructing a 2 MW Combined Heat and

Power (CHP) system that will provide electric power, heating, and cooling to their Bel Air campus—all with no

upfront costs to the hospital. UCMC partnered with Baltimore Gas and Electric (BGE), Clark Financial Services

Group, TMR Engineering, and Clark Construction Group to for this new system which increases efficiency,

provides electricity for UCMC's base load, and supplies a thermal base load for both steam and chilled water,

making it significantly more efficient than the conventional method of electricity generation. The system will

also provide backup power to ensure operations during an emergency or natural disaster.

UCMC is the first hospital Maryland to

qualify for the BGE EmPower Maryland

Incentive, receiving close to $2 million

for the system's construction.

UCMC chose the CHP system because of

its ability to provide cleaner more

efficient primary power as well as serve

as a significant backup power source

during a prolonged grid outage. The

existing diesel generators at the

hospital only serve the critical care

loads but the new system will power

more than 60% of the hospital's

electrical load. In light of recent natural

disasters, such as Superstorm Sandy,

UCMC leadership determined that additional sources of backup power were a top priority to ensure the

hospital could operate during an emergency.

UCMC will realize significant environmental benefits from this system, expecting to reduce its CO2 emissions

(by more than 40 percent) and its NOx emissions. Implementing this system is the equivalent of

permanently removing over 2,200 cars from our highways.

The UCMC CHP plant will consume significantly less water than typical power generation facilities. This

system will generate over 13 million kWh of power on-site. By utilizing the heat generated from the

system, the hospital will save nearly 1 million kWh through the new absorption chiller. In addition, steam/

hot water savings will total over 27,000 MMBtu in natural gas savings.

The project addressed several key healthcare-related

concerns that are applicable to other hospitals, such as the

need to separate critical care loads from other power needs.

UCMC is projected to save over $9 million over the

system's expected service life relative to purchasing this

power off the electric grid. Through the third-party

financing, design, construction, operations and maintenance

of the project, UCMC is blazing a trail for other hospitals to

take advantage of this unique business model.

Contact Don Allik, Facilities Manager at UCMC, for more

information.

Natural Gas Fed Generator Set—2 MW

University of Maryland Upper Chesapeake Medical Center:

Combined Heat and Power

Projected savings with the Power Purchase Agreement

Maryland Hospitals for a Healthy Environment

Monthly News Roundup

IN THIS ISSUE:

March • 2014

www.mdh2e.org

Eco Jeopardy,

the 2014 edition,

inside on Page 2!

Former western Maryland hospital provides recycled materials for county

buildings, schools In 2009 the new Western Maryland Regional Medical Center opened in

Cumberland, Maryland, resulting in the closing of two older hospitals: Memorial

Hospital and the Western Maryland Hospital System Braddock Campus (formerly

Sacred Heart).

Architects submitted a final plan for demolition for Sacred Heart Hospital last

month, bringing the date for razing of the site even closer (ownership was

transferred to The Board of Education of Allegany County in 2012). This will be

the site of the new Allegany High School, slated to open in Fall 2017.

But, even in the twilight years and months of this century old hospital, as it

awaits deconstruction, it continues to provide a community benefit and

environmental consideration by recycling furniture and building materials and

keeping demolition waste out of the landfills.

After it closed, in 2009, Sacred Heart conducted a public auction at the site,

selling most of the furnishings and equipment that occupied the space.

Continued on Page 5...

Combined heat and power system at Upper

Chesapeake Medical Center developed

under power purchase agreement In Spring, 2014 a new 2.0 MW on-site Combined Heat and Power (CHP) system

will be operational at Upper Chesapeake Medical Center (UCMC) in Bel Air, Md, a

member of the University of Maryland Medical System (UMMS). This new

system will significantly improve the electrical efficiency of the hospital.

According to a report from the American Counsel of Energy-Efficient Economy

(ACEEE), the combined thermal and electric efficiency of CHP systems usually

exceeds 70 percent, whereas the separate generation of electricity in the US

centralized grid system usually averages less than 40 percent. The improved

energy efficiency of CHP systems stem from their design to reuse exhaust heat

to simultaneously generate electrical and thermal energy. By using this system

to produce energy on the campus of UCMC it's the equivalent of taking over

2,200 cars off the road!

The CHP system will serve as the primary power source for the hospital's

electrical load, working in parallel with the local electrical utility. Furthermore,

the CHP at UCMC will greatly increase the hospital's ability to provide essential

services during an emergency including providing significant back-up power for

non-critical care loads during prolonged grid outages. During a prolonged grid

outage, the CHP and the existing hospital emergency generator can maintain

more than 60 percent of the UCMC healthcare loads.

Continued on Page 4...

Medstar Mongtomery

Champions 2

UM BWMC new

Styrofoam recycler 3

Upper Chesapeake

continued; plastics

pilot in California

4

Alliance of Nurses

for Healthy

Environments

5

March Events 6

Food Pages 7

March • 2014 Maryland H2E News Roundup

Page 4 www.mdh2e.org

California Hospital System Will Divert 110 Tons of

Packaging Material from Landfill Annually The Healthcare Plastics Recycling Council and Stanford Hospital and Clinics in Palo Alto, California recently

concluded a six-month long pilot plastics recycling study. The study analyzed data on types of materials,

volumes and flow through nine hospital departments, including operating room, ambulatory surgery, pre-

and post-anesthesia, radiology, catheter-angiography and pharmacy. To date, the program will redirect

more than 110 tons of noninfectious material from landfills, annually. In addition, Stanford has seen a

strong financial benefit in the form of 75% savings, as recycling is much less expensive than waste

collection.

According to HPRC director Tod Christenson, “...we now have detailed insight and process recommendations

for efficient, high-quality and cost-effective recycling of plastics.” The pilot study will provide crucial

informative data for other hospitals looking to establish a plastics recycling program in a clinical arena.

For more information, visit www.hprc.org. This article originally appeared at FacilityCare.com.

...continued from front page.

The system was custom designed to meet the

electrical and thermal base loads of the hospital. The

system consists of one 2.0 MW natural gas fired

generator, one 350 ton absorption chiller, one 67

boiler horsepower heat recovery steam generator

(HRSG), a cooling tower and

associated pumps, heat

exchangers and auxiliary

equipment and controls. Waste

heat from the exhaust of the

engine will be captured and

converted to steam via the heat

recovery steam boiler. The

steam generated will be utilized

in the absorption chiller,

building steam loop and at times

converted for use in other

hydronic systems, thereby

eliminating the need to purchase additional electricity

for operation.

Upper Chesapeake Medical Center (UCMC) is

obtaining this system through a partnership with

Energy and Structured Finance (ESF), a part of the

Clark Construction Group, LLC. UCMC was able to

obtain this system with no upfront capital

expenditures and is expected to save millions of

dollars on their energy costs over the life of the

system. Furthermore, UCMC was able to transfer

significant cost and operational risk to ESF by using a

power purchase agreement (PPA) structure. Under

this PPA contract, ESF provides the hospital with

performance guarantees and the hospital commits to

purchase all the electricity produced by this system.

ESF is the owner of the system,

designed by TMR Engineering of

Arlington, VA, and the hospital

has options to purchase the

project from ESF. Through this

arrangement, ESF is able to

bring tax and other incentives

into the project capital

structure that would otherwise

not be available to non-profit

organizations such as

UCMC. The UCMC project was

the first recipient of the EmPower Maryland CHP

incentive program, receiving $1.5 million of funds

under this program.

Written by Claudia M. Meer, Clark Financial Services

Group

Questions? Email Donald Allik, Director, Facilities

Services at UCMC or call at 443-643-1314

CogenerationCombined Heat and Power (CHP) Systems

1

University of Maryland Upper Chesapeake Medical Center500 Upper Chesapeake Drive

Bel Air, MD 21014

Central Plant

CHP location

2

OverviewThe Upper Chesapeake Medical Center contains a 200 bed state-of-the-art general medical and surgical hospital and medical complex, serving the residents of northeastern Maryland. The Medical Center sits on a campus in Bel Air, housing the hospital itself, two medical office buildings (MOB) Pavilion I and II, a parking garage, and the Klein Ambulatory Care Center of Harford County, which contains outpatient laboratory, testing, and surgical spaces as well as the administrative offices for Upper Chesapeake Health. The Hospital was constructed in 2000 and underwent an expansion in 2008 which included an expanded Emergency Department and the addition of a new parking garage and medical office building (Pavilion II). A new 75,000sf multidisciplinary Cancer Center was constructed on the campus and opened October 2014.

3

Electrical DistributionElectrical service to the campus is delivered via a pair of 34.5 kV feeders and a main 34.5 kV/600A service station. This service station feeds three substations located in the main building and three outdoor pad-mounted transformers serving the Klein Ambulatory Care Center, Pavilion 2, and the Kaufman Cancer Center. Substations “USA” and “USB” are 2000 kVA each and deliver 480V power to a mixture of normal, critical, life safety, and equipment loads. Substation “USC” is 3000 kVA and delivers 480Vpower to the central plant. Emergency Power is provided by one 1500KW Diesel-fired Emergency Generator located adjacent to the central plant in the rear mechanical pit. This generator feeds 6 automatic transfer switches throughout the facility which feed emergency power to various distributed emergency switchboards and panels.

4

Central PlantAdjacent to the Main Building is a Central Plant which produces and distributes steam, heating hot water, domestic hot water, and chilled water to the campus. The Central Plant contains:

• Four (4) 500-ton water-cooled chillers• Four (4) 1000-1100 gpm constant speed primary chilled water pumps • Three (3) 2250 gpm variable speed secondary pumps• Four (4) 1500 gpm cooling tower cells• Four (4) 1500 gpm constant speed condenser water pumps• (3) fire-tube steam boilers producing 100 psi steam.• One (1) 65 psig High Pressure Steam (HPS) line serves

decontamination and sterilization equipment • 20 psig Low Pressure Steam (LPS)• Four (4) steam-to-hot-water heat exchangers provide hot water to the

building VAV box reheat coils• Three (3) steam-fired domestic water heaters

5

Central Plant continued

• (3) fire-tube steam boilers producing 100 psi steam• One (1) 65 psig High Pressure Steam (HPS) line serves decontamination and

sterilization equipment • 20 psig Low Pressure Steam (LPS)• Four (4) steam-to-hot-water heat exchangers provide hot water to the

building VAV box reheat coils• Three (3) steam-fired domestic water heaters also exists at the central plant

6

CHP Major Components Power Generation and Distribution

• One (1) Caterpillar G3516H, 2.0 MW, Natural Gas generator set • PLC controller for generator • Siemens Apogee graphical user interface and computers

Chilled water production • One (1) Broad Model BHS106X, 350 ton Steam and Hot water fired

Absorption chiller • PLC controller for absorption chiller • Pumps, Valves, Control Valves and Variable-Frequency Drives (VFDs) • Alarm system

Heat Rejection• One (1) EVAPCO Model UT112 500 ton Stainless Steel Cooling Tower • One (1) Cain engine heat recovery steam generator • One (1) Engine jacket water plate heat exchanger • One (1) Heating hot water plate heat exchanger • Two (2) Engine jacket water radiators • Pumps, Valves, Control Valves, and VFDs

7

CHP Major Components continued

Engine Room Space Cooling • Three (3) Roof mounted Exhaust Fans

Sump Pump Station • Sump Pump system

Medium voltage switchboard/circuit breakers (CHP) • Protective relays (CHP and Main Central Plant) • Synchronization systems (CHP) • Meters and Instrumentation (CHP) • Batteries and chargers (CHP)

Electronic Systems:• Electronic Controls (CHP) • PLCs for Engine and Absorption Chiller • Direct Digital Control (DDC) system field devices • Square D Power Monitoring Control System

8

CHP Major Components continued

Field devices installed and utilized specifically for the CHP System operation. This includes items such as:

• Natural gas meters • Heating and cooling system flow meters • Valves, actuators, temperature and pressure sensors.

9

WAH Replacement Hospital ProjectOption 3 ‐ Capitalized Construction Interest

Date CAPI Deposit Interest @ 0.75% Principal Scheduled Draw Balance2/1/2016 21,140,327.87$ ‐$ ‐$ ‐$ 21,140,327.87$ 7/1/2016 ‐$ 66,063.52 3,497,061.48 3,563,125.00 17,643,266.39 1/1/2017 ‐$ 66,162.25 4,209,587.75 4,275,750.00 13,433,678.64 7/1/2017 ‐$ 50,376.29 4,225,373.71 4,275,750.00 9,208,304.93 1/1/2018 ‐$ 34,531.14 4,241,218.86 4,275,750.00 4,967,086.07 7/1/2018 ‐$ 18,626.57 4,257,123.43 4,275,750.00 709,962.64 1/1/2019 ‐$ 2,662.36 709,962.64 712,625.00 7/1/2019

21,140,327.87$ 238,422.13$ 21,140,327.87$ 21,378,750.00$ 67,102,626.54$

Capitalized Interest CostBond Proceeds (Deposit) 21,140,327.87$

Interest Earnings from CAPI 238,422.13 Interest Earnings From DSRF applied to CAPI ‐

Total Interest Cost 21,378,750.00$

http://bigstory.ap.org/article/report-us-births-first-time-5-years

Latest News

Report: US births up for first time in 5 years By MIKE STOBBE

May. 29, 2014 12:01 AM EDT

NEW YORK (AP) — The baby recession may be at an end: After a five-year span in which the number of

children born in the United States dropped each year, 2013 saw a minute increase.

According to a new government report, the number of babies born last year rose by about 4,700, the first

annual increase since 2007.

It's a "very, very, very slight" increase, said the lead author of the new report, Brady Hamilton of the Centers

for Disease Control and Prevention.

Experts have been blaming the downward trend mainly on the nation's economy, which was in recession from

2007 to 2009 and wobbly for at least two years after that. Many couples had money problems and felt they

couldn't afford to start or add to their family, they believe.

Now the economy has picked up and so has child-bearing, at least in women ages 30 and older — the teen

birth rate dropped sharply once again, and birth rates still fell for women in in their 20s.

Falling deliveries was a relatively new phenomenon in this country. Births were on the rise since the late 1990s

and hit an all-time high of more than 4.3 million in 2007. Then came the drop attributed to the nation's flagging

economy.

Both the number of births and birth rate fell fairly dramatically through 2010. Then the declines became

smaller. In 2012, the number of births was only a few hundred less than in 2011.

Last year's tally was a little under 4 million.

The nation also may be seeing a more pronounced shift to having children a bit later in life, said Rob

Stephenson, an Emory University demographer focused on reproductive health. That follows a trend western

Europe experienced more than a decade ago, he said.

"Maybe the new norm is having children in your 30s," he said.


The birth rate for women in their early 30s inched up in 2012 for the first time since 2007. It rose again in

2013, by 1 percent. The birth rates for women in their late 30s and early 40s rose by 3 percent and 1 percent,

respectively.

Some of these older moms probably were women who put off having kids a few years ago, when money was

tighter, but now are responding to their biological clocks, said John Santelli, a Columbia University professor

of population and family health.

"At some point, you can't wait any longer," he said.

But he also agreed that it's become more common for women to pursue education and career goals through

their 20s and delay starting families until later.

The CDC report is based on a review of more than 99 percent of U.S. birth certificates from 2012. The

government released the report Thursday.

Other highlights:

—The number of births rose a little for both white and black women. It stayed the same for Hispanic and

Native American moms. And for some reason experts can't explain, it fell 2 percent for Asian moms.

—The birth rate dropped less than 1 percent, to just under 63 births per 1,000 women of child-bearing age.

That's the lowest it's ever been, according to U.S. health records.

—The total fertility rate also fell, by 1 percent. That statistic tells how many children a woman can be expected

to have if current birth rates continue. The figure was 1.87 children last year. Experts say 2.1 is a goal if you

want to keep the population at its current size.

—A little under 33 percent of births last year were delivered through Cesarean section — a slight drop from

the rate over the previous two years. C-sections are sometimes medically necessary. But health officials

believe many are done out of convenience or unwarranted caution, and in the 1980s set a goal of keeping the

national rate at 15 percent.

—There was a continued decline in the rate of births delivered at less than 37 weeks into the pregnancy. The

preterm birth rate, as it is called, fell to about 11 percent in 2013. It has been declining since 2006.

—The teen birth rate fell 10 percent from 2012, the largest decline since the 10 percent drop between 2009 and

2010. Birth rates for teen moms have been falling since 1991 and this marks yet another historic low. The

number of babies born to teens last year — about 275,000 — is less than half the peak of nearly 645,000 in

1970.


Experts attribute the decline to a range of factors, including less sex and more use of contraception. But they

admit being stunned by the velocity of the drop.

"Everybody's wondering why, but everybody's really excited about that," Santelli said.

___

Online:

CDC: http://www.cdc.gov/nchs

Hospital Ratings Heart Surgery © Consumer reports June 2014

Hospital Ratings Heart SurgeryThe data come from the Society of Thoracic Surgeons for hospitals that have agreed to share their data with us.

BYpass sURgERY Ratings reflects a hospital’s performance in isolated coronary artery bypass graft surgery, including the open-heart approach and less invasive versions. Overall score is a composite of four measures: survival (percentage of patients who leave the hospital and survive at least 30 days after surgery), complications (percentage of patients who avoid the most serious complications, including needing a second operation, developing a deep chest infection, suffering a stroke or kidney failure, and requiring prolonged ventilation), best surgical technique (percentage of patients who receive at least one graft from an internal mammary artery, located under the breastbone, which improves survival), and right drugs (percentage of patients who receive beta-blockers before and after surgery to control blood pressure and heart rhythm, aspirin to prevent blood clots, and a drug after surgery to lower LDL (bad) cholesterol).

ValVE REplaCEMEnt Ratings reflects a hospital’s performance in surgical aortic valve replacement. Does not include data for trans-catheter aortic valve replacement, though the StS has started to collect it. Overall score is a composite of two measures: survival (percentage of patients who leave the hospital and survive at least 30 days after surgery) and complications (percentage of patients who avoid the most serious complications, which are the same as for bypass).

all data were adjusted based on the health of patients. Still, limitations of such adjustments can make direct comparisons difficult.

MoRE inFoRMation For details on our methodology, go to www.Consumerreports.org/cro/howweratehospitals. For our complete hospital ratings, subscribers to our website can go to www.Consumerreports.org/hospitalratings.

Hospital CitY CoRonaRY aRtERY BYpass sURgERY Rating

aoRtiC ValVE REplaCEMEnt sURgERY Rating

alaBaMa

east alabama Medical Center Opelika 3 —

Providence Hospital Mobile 3 —

aRiZona

Banner Boswell Medical Center Sun City 3 —

Chandler regional Medical Center Chandler 3 3Flagstaff Medical Center Flagstaff 3 3Havasu regional Medical Center Lake Havasu City 3 —

Scottsdale Healthcare Shea Medical Center Scottsdale 3 —

Scottsdale Healthcare - Osborn Medical Center Scottsdale 3 —

university of arizona Medical Center - university Campus tucson 5 3yuma regional Medical Center yuma 3 —

aRKansas

Nea Baptist Memorial Hospital Jonesboro — 3St. Bernards Medical Center Jonesboro 3 —

BELOW AVERAGE AVERAGE ABOVE AVERAGE





Hospital Ratings Heart Surgery

CaliFoRnia

alta Bates Summit Medical Center - Summit Campus Oakland 3 —

California Pacific Medical Center San Francisco 3 3Community Memorial Health System Ventura 3 3Desert regional Medical Center Palm Springs 3 3glendale adventist Medical Center glendale 3 3glendale Memorial Hospital and Health Center glendale 3 —

good Samaritan Hospital Los angeles 3 —

Hoag Memorial Hospital Presbyterian Newport Beach 3 —

Huntington Memorial Hospital Pasadena 3 —

John Muir Medical Center, Concord Concord 3 3Kaiser Permanente San Francisco Medical Center San Francisco 3 —

Kaiser Permanente Santa Clara Medical Center Santa Clara 3 —

Long Beach Memorial Medical Center Long Beach 1 3Marin general Hospital greenbrae 3 —

Mercy Medical Center redding redding 5 3Mills-Peninsula Health Services Burlingame 3 3Mission Hospital Mission Viejo 5 3NorthBay Medical Center Fairfield 3 —

Pomona Valley Hospital Medical Center Pomona 3 —

Presbyterian Intercommunity Hospital Whittier 3 —

Providence Holy Cross Medical Center Mission Hills 3 —

Providence Little Company of Mary Medical Center torrance 1 —

Providence Saint Joseph Medical Center Burbank 3 —

Providence tarzana Medical Center tarzana 3 —

Queen of the Valley Medical Center Napa 1 —

ronald reagan university of California Los angeles Medical Center Los angeles 3 5Saddleback Memorial Medical Center Laguna Hills 3 —

Salinas Valley Memorial Healthcare System Salinas 3 3San ramon regional Medical Center San ramon 3 —

Santa rosa Memorial Hospital Santa rosa 3 —






CaliFoRnia (continued)

Sequoia Hospital redwood City 5 5Sharp Chula Vista Medical Center Chula Vista 3 3Sharp grossmont Hospital La Mesa 3 3Sharp Memorial Hospital San Diego 3 3St. John's regional Medical Center Oxnard 3 —

St. Joseph Hospital Orange 3 3St. Joseph's Medical Center Stockton 5 3St. Jude Medical Center Fullerton 5 —

Stanford Hospital and Clinics Palo alto 3 5torrance Memorial Medical Center torrance 3 —

university of California, Davis Medical Center Sacramento 3 —

Washington Hospital Healthcare System Fremont 3 —

ColoRaDo

exempla Lutheran Medical Center Wheat ridge 3 3exempla Saint Joseph Hospital Denver 3 3Medical Center of the rockies Loveland 3 —

Memorial Health System Colorado Springs 3 3North Colorado Medical Center greeley 3 3Penrose-St. Francis Health Services Colorado Springs 3 3university of Colorado Hospital aurora 3 3DElaWaRE

Bayhealth Medical Center Dover 3 3Beebe Medical Center Lewes 3 —

Christiana Care Health System Newark 3 3DistRiCt oF ColUMBia

george Washington university Hospital Washington 3 —

MedStar Washington Hospital Center Washington 5 —

FloRiDa

Cleveland Clinic Florida Weston 3 3Delray Medical Center Delray Beach 3 3






FloRiDa (continued)

Holy Cross Hospital Fort Lauderdale 3 3Indian river Medical Center Vero Beach 3 —

Lakeland regional Medical Center Lakeland 3 —

Leesburg regional Medical Center Leesburg 1 —

Memorial regional Hospital Hollywood 5 3Morton Plant Hospital Clearwater 3 3Munroe regional Medical Center Ocala 5 —

NCH Downtown Naples Hospital (Naples Community Hospital) Naples 3 —

Orlando regional Medical Center Orlando 3 3Sarasota Memorial Hospital Sarasota 5 3St. Joseph's Hospital tampa 5 —

Venice regional Medical Center Venice 5 3Winter Haven Hospital Winter Haven 5 3gEoRgia

athens regional Medical Center athens 3 —

Piedmont Hospital atlanta 3 3Saint Joseph's Hospital of atlanta atlanta 3 —

St. Francis Hospital Columbus 3 —

WellStar Kennestone Hospital Marietta 5 —

HaWaii

Straub Clinic & Hospital Honolulu 3 —

iDaHo

Kootenai Medical Center Coeur D'alene 3 3Portneuf Medical Center Pocatello 3 3Saint alphonsus regional Medical Center Boise — 3St. Luke's regional Medical Center Boise 3 3illinois

adventist Hinsdale Hospital Hinsdale 3 3adventist La grange Memorial Hospital La grange 3 3advocate BroMenn Medical Center Normal 3 3






illinois (continued)

advocate Christ Medical Center Oak Lawn 5 3advocate Condell Medical Center Libertyville 5 3advocate good Samaritan Hospital Downers grove 5 3advocate good Shepherd Hospital Barrington 3 3advocate Illinois Masonic Medical Center Chicago 3 3advocate Lutheran general Hospital Park ridge 3 3advocate Sherman Hospital elgin 5 3Central DuPage Hospital Winfield 5 —

edward Hospital Naperville 3 3elmhurst Memorial Hospital elmhurst 3 3Memorial Medical Center Springfield 3 —

MetroSouth Medical Center Blue Island 3 3Northwestern Memorial Hospital Chicago 3 —

OSF Saint anthony Medical Center rockford 3 1OSF Saint Francis Medical Center Peoria 3 —

Palos Community Hospital Palos Heights 3 —

Presence Covenant Medical Center urbana 3 —

Presence Mercy Medical Center aurora 3 —

Presence resurrection Medical Center Chicago 3 —

Presence Saint Joseph Hospital Chicago 3 3Presence Saint Joseph Hospital elgin 3 —

Presence Saints Mary & elizabeth Medical Center Chicago 3 —

rockford Memorial Hospital rockford 3 —

St. John's Hospital (Prairie Heart Institute) Springfield 3 3Swedish Covenant Hospital Chicago 3 —

Swedishamerican Hospital rockford 5 —

university of Chicago Medical Center Chicago — 3inDiana

Community Heart and Vascular Hospital (the Indiana Heart Hospital) Indianapolis 1 —

elkhart general Healthcare System elkhart 3 —






inDiana (continued)

Franciscan St. anthony Health - Crown Point Crown Point 3 —

Franciscan St. anthony Health - Michigan City Michigan City 3 —

Franciscan St. elizabeth Health - Lafayette east Lafayette 3 —

Franciscan St. Francis Health - Indianapolis Indianapolis 5 3Indiana university Health arnett Hospital Lafayette 3 —

Indiana university Health Ball Memorial Hospital Muncie 3 3Indiana university Health Bloomington Hospital Bloomington 5 3Indiana university Health La Porte Hospital La Porte 3 —

Indiana university Health university Hospital Indianapolis 3 3Lutheran Hospital of Indiana Fort Wayne 3 3Memorial Hospital of South Bend South Bend 3 —

Parkview regional Medical Center (Parkview Heart Institute) Fort Wayne 5 3St. Vincent Heart Center of Indiana Indianapolis 5 5St. Vincent Indianapolis Hospital Indianapolis 3 3ioWa

Mercy Iowa City Iowa City 3 3Mercy Medical Center - Des Moines Des Moines 3 1Mercy Medical Center - Dubuque Dubuque 3 —

Mercy Medical Center - North Iowa Mason City 3 3unityPoint Health - allen Hospital Waterloo 3 3unityPoint Health - Iowa Methodist Medical Center Des Moines 3 3Kansas

Olathe Medical Center Olathe 3 —

Salina regional Health Center Salina 3 —

Stormont-Vail HealthCare topeka 5 —

KEntUCKY

Baptist Health Lexington Lexington 3 —

Baptist Health Madisonville Madisonville 3 —

Baptist Health Paducah Paducah 5 —

Jewish Hospital Louisville 1 1






KEntUCKY (continued)

King's Daughters Medical Center ashland 5 —

Lourdes Hospital Paducah 3 3Norton audubon Hospital Louisville 3 3Norton Hospital Louisville 3 3loUisiana

Baton rouge general Medical Center Baton rouge 3 3CHrIStuS St. Patrick Hospital of Lake Charles Lake Charles 1 3glenwood regional Medical Center West Monroe 3 3Heart Hospital of Lafayette Lafayette 3 —

Ochsner Medical Center - Baton rouge Baton rouge 3 3Our Lady of the Lake regional Medical Center Baton rouge 3 —

MaRYlanD

MedStar union Memorial Hospital Baltimore 3 3Suburban Hospital Bethesda 3 —

Washington adventist Hospital takoma Park 5 —

MassaCHUsEtts

Baystate Medical Center Springfield 5 5Beth Israel Deaconess Medical Center Boston 3 3Boston Medical Center Boston 3 —

Brigham and Women's Hospital Boston 3 5Cape Cod Hospital Hyannis 3 3Lahey Hospital & Medical Center, Burlington Burlington 5 3Massachusetts general Hospital Boston 3 5Mount auburn Hospital Cambridge 5 3North Shore Medical Center Salem 3 3Saint Vincent Hospital Worcester 3 3Southcoast Hospitals group Fall river 3 3tufts Medical Center Boston 3 3uMass Memorial Medical Center Worcester 5 5






MiCHigan

allegiance Health Jackson 3 3Beaumont Hospital - royal Oak royal Oak 3 3Beaumont Hospital - troy troy 3 3Borgess Medical Center Kalamazoo 5 5Bronson Methodist Hospital Kalamazoo 3 3Covenant Medical Center Saginaw 3 3Crittenton Hospital Medical Center rochester 5 3genesys regional Medical Center grand Blanc 5 3Henry Ford Hospital Detroit 5 3Henry Ford Macomb Hospitals Clinton township 5 3Lakeland regional Medical Center - St. Joseph Saint Joseph 3 3Marquette general Health System Marquette 3 3McLaren Bay region Bay City 5 —

McLaren Flint Flint 3 3McLaren greater Lansing Lansing 3 3McLaren Macomb Mount Clemens 3 3McLaren Northern Michigan Petoskey 5 3Mercy Health Partners, Mercy Campus Muskegon 3 —

MidMichigan Medical Center - Midland Midland 3 —

Munson Medical Center traverse City 3 —

Oakwood Hospital & Medical Center - Dearborn Dearborn 3 —

Port Huron Hospital Port Huron 3 3Providence Hospital Southfield 3 3Sinai-grace Hospital Detroit 3 3Sparrow Hospital Lansing 3 —

Spectrum Health - grand rapids (Meijer Heart Center) grand rapids 5 5St. John Hospital and Medical Center Detroit 3 3St. John Macomb - Oakland Hospital Warren 5 3St. Joseph Mercy Hospital ypsilanti 5 5St. Joseph Mercy Oakland Pontiac 3 —






MiCHigan (continued)

St. Mary's of Michigan Saginaw 3 3university of Michigan Hospitals and Health Centers ann arbor 3 5MinnEsota

abbott Northwestern Hospital Minneapolis 3 3essentia Health St. Mary's Medical Center Duluth 3 3Fairview Southdale Hospital edina 1 3Hennepin County Medical Center Minneapolis 3 3Mercy Hospital Coon rapids 3 3North Memorial Medical Center robbinsdale 1 3Park Nicollet Methodist Hospital Saint Louis Park 3 3regions Hospital Saint Paul 3 3St. Cloud Hospital Saint Cloud 5 —

St. Joseph's Hospital Saint Paul 3 3united Hospital Saint Paul 3 3university of Minnesota Medical Center, Fairview Minneapolis 3 3Mississippi

Mississippi Baptist Medical Center Jackson 3 3university Hospitals and Health System, university of Mississippi Medical Center

Jackson 3 —

MissoURi

Boone Hospital Center Columbia 5 3Heartland regional Medical Center Saint Joseph 3 —

Mercy Hospital Joplin Joplin 3 —

Missouri Baptist Medical Center Saint Louis 3 5Poplar Bluff regional Medical Center Poplar Bluff 1 3Saint Francis Medical Center Cape girardeau 3 3Saint Luke's Hospital of Kansas City Kansas City 3 —

Montana

Billings Clinic Billings 3 3St. Patrick Hospital Missoula 3 3






nEBRasKa

alegent Creighton Health Bergan Mercy Medical Center Omaha 3 3alegent Creighton Health - Creighton university Medical Center Omaha 3 3Bryan Medical Center Lincoln 5 3good Samaritan Hospital Kearney 3 —

Nebraska Heart Hospital Lincoln 5 3Nebraska Medical Center Omaha 3 —

Nebraska Methodist Hospital Omaha 3 3nEVaDa

Desert Springs Hospital Medical Center Las Vegas 1 1MountainView Hospital Las Vegas 3 3Summerlin Hospital Medical Center Las Vegas 3 —

university Medical Center Las Vegas 3 3Valley Hospital Medical Center Las Vegas 3 3nEW HaMpsHiRE

Catholic Medical Center Manchester 5 3nEW JERsEY

atlantiCare regional Medical Center atlantic City 3 —

englewood Hospital and Medical Center englewood 3 3Jersey Shore university Medical Center Neptune 3 3Morristown Medical Center Morristown 5 3Valley Hospital ridgewood 5 5nEW MEXiCo

Presbyterian Hospital albuquerque 5 —

nEW YoRK

albany Medical Center albany 3 5ellis Hospital Schenectady 3 3good Samaritan Hospital Suffern 3 3Kaleida Health (gates Vascular Institute at Buffalo general Medical Center)

Buffalo 5 5Lenox Hill Hospital New york 3 —






nEW YoRK (continued)

Mercy Hospital Buffalo 5 3Montefiore Medical Center Bronx 5 3Nyu Langone Medical Center New york 3 3rochester general Hospital rochester 5 3St. elizabeth Medical Center utica 3 3St. Joseph's Hospital Health Center Syracuse 5 5St. Peter's Hospital albany 3 3Strong Memorial Hospital of the university of rochester rochester 3 3upstate university Hospital Syracuse 3 —

Westchester Medical Center Valhalla 3 —

noRtH CaRolina

Carolinas Medical Center Charlotte 5 3Cone Health greensboro 5 3Duke university Hospital Durham 3 5FirstHealth Moore regional Hospital Pinehurst 3 —

High Point regional Health System High Point 5 —

Mission Hospital asheville 5 —

Novant Health Forsyth Medical Center Winston-Salem 3 3Novant Health Presbyterian Medical Center Charlotte 3 3university of North Carolina Hospitals Chapel Hill 3 —

Wake Forest Baptist Medical Center Winston-Salem 3 3WakeMed raleigh Campus raleigh 3 —

noRtH DaKota

altru Health System grand Forks 3 3essentia Health Fargo (essentia West - Innovis Health) Fargo 3 3Sanford Bismarck Bismarck 3 3St. alexius Medical Center Bismarck 3 3oHio

adena Medical Center Chillicothe 3 —

affinity Medical Center Massillon 3 3






oHio (continued)

akron general Medical Center akron 3 —

aultman Hospital Canton 5 3Blanchard Valley Hospital Findlay 3 —

Cleveland Clinic Cleveland 5 5Fairfield Medical Center Lancaster 3 —

Lake Health Concord township 3 3Lima Memorial Health System Lima 3 —

Mercy Health - anderson Hospital Cincinnati 3 —

Mercy St. Vincent Medical Center toledo 3 —

Mount Carmel east Hospital Columbus 5 3Mount Carmel West Hospital Columbus 3 3Northside Medical Center youngstown 3 —

Ohio State university Wexner Medical Center Columbus 3 3OhioHealth Doctors Hospital Columbus 3 —

OhioHealth Marion general Hospital Marion 3 —

ProMedica toledo Hospital toledo 3 3the university of toledo Medical Center toledo 3 3oKlaHoMa

Comanche County Memorial Hospital Lawton 3 —

Integris Baptist Medical Center Oklahoma City 1 —

Integris Bass Baptist Health Center enid 3 —

Norman regional Health System Norman 1 —

Oklahoma Heart Hospital Oklahoma City 5 —

Oklahoma Heart Hospital South Campus Oklahoma City 3 —

oREgon

Kaiser Permanente Sunnyside Medical Center Clackamas 5 5Legacy emanuel Hospital and Health Center Portland 3 —

Legacy good Samaritan Hospital and Medical Center Portland 3 3McKenzie-Willamette Medical Center Springfield 3 3OHSu Hospital Portland 1 —






oREgon (continued)

Providence Portland Medical Center Portland 3 3Providence St. Vincent Medical Center Portland 3 3rogue Valley Medical Center Medford 3 3tuality Healthcare Hillsboro 3 —

pEnnsYlVania

Bryn Mawr Hospital Bryn Mawr 3 —

Butler Health System Butler 3 3Chester County Hospital West Chester 3 —

Conemaugh Memorial Medical Center Johnstown 3 —

Doylestown Hospital Doylestown 3 —

DuBois regional Medical Center Du Bois 3 —

excela Health Westmoreland Hospital greensburg 5 3Forbes regional Hospital Monroeville 3 3geisinger Medical Center Danville 3 —

geisinger Wyoming Valley Medical Center Wilkes Barre 3 —

geisinger - Community Medical Center Scranton 3 3Heritage Valley Beaver Beaver 3 1Lancaster general Health Lancaster 3 3Lankenau Medical Center Wynnewood 5 3Lehigh Valley Hospital allentown 3 5Lehigh Valley Hospital - Muhlenberg Bethlehem 3 3Paoli Hospital Paoli 3 —

Pinnacle Health System Harrisburg 5 —

Pocono Medical Center east Stroudsburg 3 —

reading Hospital and Medical Center West reading 3 3Saint Vincent Hospital erie 3 —

St. Clair Memorial Hospital Pittsburgh 3 3St. Luke's university Hospital - Bethlehem Campus Bethlehem 3 3temple university Hospital Philadelphia — 3the good Samaritan Hospital Lebanon 5 3






pEnnsYlVania (continued)

uPMC Hamot erie 3 3Washington Hospital Washington 3 —

Wilkes-Barre general Hospital Wilkes-Barre 5 —

Williamsport regional Medical Center Williamsport 3 —

york Hospital york 5 —

soUtH CaRolina

anMed Health Medical Center anderson 3 3greenville Memorial Hospital greenville 3 —

Hilton Head Hospital Hilton Head Island 3 —

McLeod regional Medical Center Florence 3 —

Providence Hospital Columbia 5 1roper Hospital Charleston 3 —

soUtH DaKota

Sanford uSD Medical Center Sioux Falls 3 3tEnnEssEE

Fort Sanders regional Medical Center Knoxville 3 3Jackson-Madison County general Hospital Jackson 3 —

Johnson City Medical Center Johnson City 5 3Methodist Medical Center of Oak ridge Oak ridge 3 3Parkwest Medical Center Knoxville 5 3Saint thomas Midtown Hospital Nashville 3 3Saint thomas West Hospital Nashville 5 3tristar Centennial Medical Center Nashville 3 3university of tennessee Medical Center Knoxville 3 3Wellmont Bristol regional Medical Center Bristol 5 3Wellmont Holston Valley Medical Center Kingsport 3 3tEXas

Baylor all Saints Medical Center at Fort Worth Fort Worth 3 —

Baylor Medical Center at garland garland 3 —

Baylor Medical Center at Irving Irving 3 —






tEXas (continued)

Baylor regional Medical Center at grapevine grapevine 3 3Baylor university Medical Center Dallas 3 3Covenant Medical Center Lubbock 3 —

Cypress Fairbanks Medical Center Houston 3 —

Doctor's Hospital at renaissance edinburg 3 3Lake Pointe Medical Center rowlett 3 —

Las Palmas/Del Sol Medical Center el Paso 1 —

Midland Memorial Hospital Midland 3 —

Mother Frances Hospital - tyler tyler 5 5St. Joseph regional Health Center Bryan 3 3St. Luke's episcopal Hospital Houston — 3St. Luke's the Woodlands Hospital the Woodlands 1 3texas Health Heart & Vascular Hospital arlington arlington 3 —

the Heart Hospital Baylor Plano Plano 5 5university Medical Center Lubbock 1 —

university of texas Southwestern Medical Center (Saint Paul) Dallas 3 3UtaH

Dixie regional Medical Center Saint george 3 3Intermountain Medical Center Murray 3 3McKay-Dee Hospital Center Ogden 5 —

utah Valley regional Medical Center Provo 5 3ViRginia

Carilion Medical Center roanoke 3 —

Centra Lynchburg general Hospital Lynchburg 3 3Inova alexandria Hospital alexandria 3 —

Inova Fairfax Hospital Falls Church 5 —

Mary Washington Hospital Fredericksburg 5 3Sentara Virginia Beach general Hospital Virginia Beach 3 3university of Virginia Medical Center Charlottesville 3 5Winchester Medical Center Winchester 3 3






WasHington

Harrison Medical Center Bremerton 3 —

PeaceHealth St. Joseph Medical Center Bellingham 3 3Providence regional Medical Center everett everett 3 3Providence Sacred Heart Medical Center & Children's Hospital Spokane 3 —

Providence St. Peter Hospital Olympia 3 3St. Joseph Medical Center tacoma 3 3Swedish Medical Center - Cherry Hill Campus Seattle 5 5university of Washington Medical Center Seattle 3 3WEst ViRginia

Camden Clark Medical Center Parkersburg 3 3Monongalia general Hospital Morgantown 1 —

West Virginia university Hospitals Morgantown 3 —

WisConsin

aspirus Wausau Hospital Wausau 3 3aurora BayCare Medical Center green Bay 3 —

Bellin Memorial Hospital green Bay 3 3Columbia St. Mary's Hospital Milwaukee Milwaukee 3 —

Columbia St. Mary's Ozaukee Hospital Mequon 3 —

Community Memorial Hospital Menomonee Falls 3 3Froedtert Memorial Lutheran Hospital Milwaukee 3 —

gundersen Lutheran Medical Center La Crosse 5 3St. Mary's Hospital Madison 3 —

university of Wisconsin Hospital and Clinics Madison 3 3Waukesha Memorial Hospital Waukesha 3 —

WYoMing

Cheyenne regional Medical Center Cheyenne 3 3

32 consumer reports august 2 01 4

Where should you go for heart surgery?Our new Ratings of more than 400 hospitals

can help you find the right one

Last spring, when Zvi Frankel’s grandfather learned that a valve in his heart needed to be replaced, he turned to his grandson for help.

The grandfather, who lives in New York City, had to choose between the standard open-heart surgery and a less invasive, high-tech version. The new option, called trans-catheter aortic valve replacement, was appealing. He wouldn’t have to be placed on a heart-lung machine or have his heart tem-porarily stopped.

But Frankel and his grandfather wanted to know more. Which worked best long term? Which was safer? And most impor-tant, which hospitals and surgeons had the best results? “Doesn’t everyone want to know that when they face something as serious as heart surgery?” Frankel asks.

Well, most people probably do want that information. But, as Frankel found out, get-ting it is far from easy. In fact, Frankel em-barked on what turned into a long quest, ending with him writing an article in JAMA Internal Medicine on how difficult it was for consumers to find needed information.

Along the way he found that many hos-pitals were eager to talk about the benefits of the new procedure, which involves insert-ing an artificial valve through an incision in the groin and threading it up an artery to the heart. Several hospitals even pro-moted it in ads or website videos, such as one we found from New York-Presbyterian hospital in New York City narrated by Meh-met Oz, M.D., director of the hospital’s Cardiovascular Institute.

But the hospitals and surgeons could not or would not tell Frankel what he most wanted to know. It took weeks poring over medical journals to learn that the limited research to date suggests that although the procedure can be the only option for some very sick people, it may be more likely than the traditional approach to cause some seri-ous complications. He found that those in-creased risks included the need for a pacemaker and death from aortic regurgita-tion, triggered when blood leaks around the new valve and back into the heart.

Most difficult was learning how well par-ticular doctors and hospitals performed. In

fact, he ended up filing a Freedom of Infor-mation Act request with New York state to get success rates for the doctors and hospitals they were considering. Ultimately, his grandfather chose the traditional approach, performed by a surgeon with a good track record at Weill Cornell Medical Center in New York City, according to the data from the state registry. The surgery was a success.

“It shouldn’t be so hard,” says John Santa, M.D., medical director of Consumer Reports Health, who helped Frankel publish his ar-ticle. “Not everyone has a grandson like Zvi to act as a full-time medical detective. Hos-pitals and doctors should make the informa-tion accessible and understandable, so families can make informed choices when they make life and death decisions.”

Our first ever Ratings of hospitals for heart surgery (see page 34) are an attempt to help you do just that.

Opening up heart dataWe rate hospitals on two heart surgeries: surgical aortic valve replacement, the kind chosen by Frankel’s grandfather; and Ph

oto

: Ro

nn

ie A

nd

Ren

heart quest Zvi Frankel and his grandfather searched extensively to

find the right heart hospital.

august 2 01 4 ConsumerReports.org 33

1. Isn’t heart surgery an emergency, so do I have time to research hospi-tals? If you are having a heart attack, emergency bypass surgery is sometimes necessary. But in most cases heart dis-ease can be stabilized with drugs or sim-pler procedures, giving you, or a friend or family member, time. ask your doctor how serious your condition is and how soon you’ll need surgery. Valve disease is serious but rarely an emergency, so you will almost always have time.

2. What should I do if my hospital isn’t rated? there’s a good chance of that happening, because many hospitals did not share data with us. But almost every hospital reports to the society of thoracic surgeons even if the informa-tion is not public. some that do report to the sts give similar data to state reg-istries. so ask your surgeon about the hospital’s survival and complication rates. If he or she can’t—or won’t—share it, consider looking elsewhere.

3. What should I do if no top hospi-tals are in my community? First, don’t panic. a hospital that gets an average rating still provides good care. If all hos-pitals in your area get low scores or won’t share their data, you could travel elsewhere. But check with your insur-ance to make sure the procedure will be covered at the out-of-town hospital. and realize that you might not have as much support from family and friends. If you choose a lower-rated hospital, discuss your concerns about its score

6 questions to help you find a heart hospitalwith your surgeon. that can be reassur-ing and help you prepare for your stay.

4. Do I need to go to a famous hospi-tal or one in a large city to get good care? No. We found top hospitals in by-pass and valve surgery in out-of-the-way places. and high-scoring hospitals in one or the other procedure are in all regions of the country.

5. What if my insurer won’t cover the hospital I want? If you have original Medicare, you should have no problem, because almost all hospitals accept it. With managed care, including Medicare advantage, you must use providers in the plan’s network or you’re likely to pay all or most of the costs out of your own pocket. If the surgery can be postponed for several months, you could consider switching plans for 2015. that may not be possible if you’re covered through a job, but if you have Medicare advantage or a plan you bought through a state market-place, you can switch plans during the annual fall open enrollment period.

6. What if I also want information about my heart surgeon? that can be difficult to find. subscribers to our web-site can see Ratings for heart surgery groups (go to ConsumerReports.org/heartsurgerygroups) but not individual doctors. a few states maintain registries for surgeons. (Contact your state’s de-partment of health.) But you probably will need to ask your surgeon for the in-formation you want. If he or she won’t tell you, consider going elsewhere.

Top-scoring hospitals

• Baystate Medical Center, Springfield, Mass.• Borgess Medical Center, Kalamazoo, Mich.• Cleveland Clinic, Cleveland• Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore.• Kaleida Health (Gates Vascular Institute at Buffalo General Medical Center), Buffalo, N.Y.• Mother Frances Hospital-Tyler, Tyler, Texas• Sequoia Hospital, Redwood City, Calif.• Spectrum Health - Grand Rapids (Meijer Heart Center), Grand Rapids, Mich.• St. Joseph Mercy Hospital, Ypsilanti, Mich.• St. Joseph’s Hospital Health Center, Syracuse, N.Y. • St. Vincent Heart Center of Indiana, Indianapolis• Swedish Medical Center-Cherry Hill Campus, Seattle• The Heart Hospital Baylor Plano, Plano, Texas• UMass Memorial Medical Center, Worces-ter, Mass.• Valley Hospital, Ridgewood, N.J.

Only 15 of the hospitals that share their data with us earned top marks in bypass and valve surgeries (listed alphabetically):

coronary artery bypass graft surgery, an equally serious operation done to treat blocked coronary arteries.

The Ratings are based on the gold stan-dard in tracking hospital performance: data from patients’ medical records showing whether patients survived the procedure and how they fared on other important measures, including complications. To cre-ate a level playing field, the data are ad-justed for the health of patients because certain hospitals treat more older, sicker patients than others.

The information comes from the Society of Thoracic Surgeons, which represents phy-sicians who operate on the heart and other organs in the chest. The STS has collected the data for several decades. More than 1,000 U.S. hospitals report to the STS, but only about 400 allowed the organization to share the data with us.

“All hospitals know this information,”

Santa says. “Those that have agreed to share, especially those with low scores, should be applauded for their commitment to trans-parency. Those that haven’t shared should make it available—otherwise, it seems like they have something to hide.”

What we foundHere are some of our main findings:• Certain famous hospitals are missing. They aren’t in our Ratings because they don’t share data with us, the STS, or both. That includes two hospitals Frankel’s grandfather considered, Columbia-Presbyterian and Weill Cornell. Also on that list: Cedars-Sinai Medical Center in Los Angeles, Johns Hop-kins Hospital in Baltimore, and the Mayo Clinic in Rochester, Minn.• Top hospitals are in surprising places. Only 15 hospitals in our Ratings earned top scores in heart-valve and bypass surgeries. Although the well-known Cleveland Clinic

made the list, so did some less familiar hos-pitals, such as Borgess Medical Center in Kalamazoo, Mich., and Mother Frances Hospital-Tyler in Tyler, Texas. Some are ma-jor medical centers; others are smaller. “It’s not name or location or ad budget that mat-ters; it’s a commitment to quality, and that can happen anywhere,” Santa says. • Performance varies widely, even at neigh-boring hospitals. We found four metro-politan areas—Indianapolis, Los Angeles,

Cleveland Clinic, Cleveland

Mother Frances hospital-tyler, tyler, texas

34 consumer reports august 2 01 4

Hospital name City Heart bypass surgery

Aortic valve replacement

surgery

NORTHEASTMassachusetts Baystate Medical Center Springfield &Z &Z

Brigham and Women’s Hospital Boston &C &ZLahey Hospital & Medical Center, Burlington Burlington &Z &CMassachusetts General Hospital Boston &C &ZMount Auburn Hospital Cambridge &Z &CUMass Memorial Medical Center Worcester &Z &Z

New Hampshire Catholic Medical Center Manchester &Z &CNew Jersey Morristown Medical Center Morristown &Z &C

Valley Hospital Ridgewood &Z &ZNew York Albany Medical Center Albany &C &Z

Kaleida Health (Gates Vascular Institute at Buffalo General Medical Center) Buffalo &Z &ZMercy Hospital Buffalo &Z &CMontefiore Medical Center Bronx &Z &CRochester General Hospital Rochester &Z &CSt. Joseph’s Hospital Health Center Syracuse &Z &Z

Pennsylvania Excela Health Westmoreland Hospital Greensburg &Z &CLankenau Medical Center Wynnewood &Z &CLehigh Valley Hospital Allentown &C &ZPinnacle Health System Harrisburg &Z —The Good Samaritan Hospital Lebanon &Z &CWilkes-Barre General Hospital Wilkes-Barre &Z —York Hospital York &Z —

SOUTHDistrict of Columbia MedStar Washington Hospital Center Washington &Z —

Florida Memorial Regional Hospital Hollywood &Z &CMunroe Regional Medical Center Ocala &Z —Sarasota Memorial Hospital Sarasota &Z &CSt. Joseph’s Hospital Tampa &Z —Venice Regional Medical Center Venice &Z &CWinter Haven Hospital Winter Haven &Z &C

Georgia WellStar Kennestone Hospital Marietta &Z —Kentucky Baptist Health Paducah Paducah &Z —

King’s Daughters Medical Center Ashland &Z —Maryland Washington Adventist Hospital Takoma Park &Z —North Carolina Carolinas Medical Center Charlotte &Z &C

Cone Health Greensboro &Z &CDuke University Hospital Durham &C &ZHigh Point Regional Health System High Point &Z —Mission Hospital Asheville &Z —

Oklahoma Oklahoma Heart Hospital Oklahoma City &Z —South Carolina Providence Hospital Columbia &Z &BTennessee Johnson City Medical Center Johnson City &Z &C

Parkwest Medical Center Knoxville &Z &CSaint Thomas West Hospital Nashville &Z &CWellmont Bristol Regional Medical Center Bristol &Z &C

Texas Mother Frances Hospital-Tyler Tyler &Z &ZThe Heart Hospital Baylor Plano Plano &Z &Z

Virginia Inova Fairfax Hospital Falls Church &Z —Mary Washington Hospital Fredericksburg &Z &CUniversity of Virginia Medical Center Charlottesville &C &Z

Hospitals in our Ratings that earned a top score in either bypass or heart-valve surgery. In alphabetical order, within state and region.

Ratings Hospitals for heart surgeryOklahoma City, and Portland, Ore.—where there are top- and low-scoring hospitals, sometimes just miles apart. “In those com-munities, the hospital you choose can really make a difference,” Santa says. • Many hospitals do a good job. Of the hos-pitals that shared their bypass data with us, 20 percent (83) were above average, 75 per-cent (310) were average, and 4 percent (18) were below average. The STS has high stan-dards, so hospitals with average scores still do a very good job, says Robbin Cohen, M.D., an associate professor of cardiotho-racic surgery at the Keck School of Medicine at the University of Southern California and a member of the STS. Of the 247 hospitals with data on valve surgery, 10 percent (25) got a top score, 87 percent (216) a middle score, and 2 percent (6) the lowest one.

The risks of heart surgeryNo one undergoes heart surgery lightly.

Bypass is usually reserved for people with multiple coronary arteries blocked with plaque, which increases the risk of heart attack and causes chest pain and shortness of breath. During the procedure, the sur-geon opens the chest, removes part of a healthy vein or artery from another part of the body, and grafts one end of it below the clog and the other end above it, allowing blood flow to bypass the blockage.

Aortic valve replacement is mostly done when the valve in the heart’s left chamber accumulates calcium deposits, obstructing blood flow. Over time, the heart fails as it struggles to keep blood pumping.

Even in the hands of skilled surgeons at good hospitals, the procedures can some-times lead to heart attack, kidney failure, or other problems. After surgery, patients are put on a ventilator, which increases the risk of complications, including pneumonia and other infections.

“No surgeon and no hospital can do heart surgery with zero complications and zero deaths,” Cohen says. “Patients undergo heart surgery because the benefits outweigh the risks.” But as our Ratings show, results vary among hospitals. So which hospital you choose matters.

Frankel ultimately got enough informa-tion to make a decision, but he says that efforts such as our new heart Ratings would have helped. When confronting surgery, people need to know they are making a deci-sion based on facts, Frankel says. “You can choose the best doctor and best hospital, and you still may not have positive results,” he says. “But people should be able to know they did everything they possibly could.”

august 2 01 4 ConsumerReports.org 35

Hospital name City Heart bypass surgery

Aortic valve replacement

surgery

MIDWESTIllinois Advocate Christ Medical Center Oak Lawn &Z &C

Advocate Condell Medical Center Libertyville &Z &CAdvocate Good Samaritan Hospital Downers Grove &Z &CAdvocate Sherman Hospital Elgin &Z &CCentral DuPage Hospital Winfield &Z —SwedishAmerican Hospital Rockford &Z —

Indiana Franciscan St. Francis Health-Indianapolis Indianapolis &Z &CIndiana University Health Bloomington Hospital Bloomington &Z &CParkview Regional Medical Center (Parkview Heart Institute) Fort Wayne &Z &CSt. Vincent Heart Center of Indiana Indianapolis &Z &Z

Kansas Stormont-Vail HealthCare Topeka &Z —Michigan Borgess Medical Center Kalamazoo &Z &Z

Crittenton Hospital Medical Center Rochester &Z &CGenesys Regional Medical Center Grand Blanc &Z &CHenry Ford Hospital Detroit &Z &CHenry Ford Macomb Hospitals Clinton Township &Z &CMcLaren Bay Region Bay City &Z —McLaren Northern Michigan Petoskey &Z &CSpectrum Health - Grand Rapids (Meijer Heart Center) Grand Rapids &Z &ZSt. John Macomb-Oakland Hospital Warren &Z &CSt. Joseph Mercy Hospital Ypsilanti &Z &ZUniversity of Michigan Hospitals and Health Centers Ann Arbor &C &Z

Minnesota St. Cloud Hospital Saint Cloud &Z —Missouri Boone Hospital Center Columbia &Z &C

Missouri Baptist Medical Center Saint Louis &C &ZNebraska Bryan Medical Center Lincoln &Z &C

Nebraska Heart Hospital Lincoln &Z &COhio Aultman Hospital Canton &Z &C

Cleveland Clinic Cleveland &Z &ZMount Carmel East Columbus &Z &C

Wisconsin Gundersen Lutheran Medical Center La Crosse &Z &CWEST

Arizona University of Arizona Medical Center-University Campus Tucson &Z &C

California Mercy Medical Center Redding Redding &Z &CMission Hospital Mission Viejo &Z &CRonald Reagan University of California Los Angeles Medical Center Los Angeles &C &ZSequoia Hospital Redwood City &Z &ZSt. Joseph’s Medical Center Stockton &Z &CSt. Jude Medical Center Fullerton &Z —Stanford Hospital and Clinics Palo Alto &C &Z

New Mexico Presbyterian Hospital Albuquerque &Z —

Oregon Kaiser Permanente Sunnyside Medical Center Clackamas &Z &Z

Utah McKay-Dee Hospital Center Ogden &Z —Utah Valley Regional Medical Center Provo &Z &C

Washington Swedish Medical Center- Cherry Hill Campus Seattle &Z &Z

How we rate hospitals on heart surgerythe data come from the society of thoracic surgeons for hospitals that have agreed to share their data with us.

Bypass surgery raTINgs Reflects a hospital’s performance in isolated coronary artery bypass graft surgery, including the open-heart approach and less invasive ver-sions. Overall score is a composite of four measures: survival (percentage of patients who leave the hospital and survive at least 30 days after surgery), complications (per-centage of patients who avoid the most seri-ous complications, including needing a second operation, developing a deep chest in-fection, suffering a stroke or kidney failure, and requiring prolonged ventilation), best surgical technique (percentage of patients who receive at least one graft from an inter-nal mammary artery, located under the breastbone, which improves survival), and right drugs (percentage of patients who re-ceive beta- blockers before and after surgery to control blood pressure and heart rhythm, aspirin to prevent blood clots, and a drug af-ter surgery to lower LDL (bad) cholesterol).

VaLVe repLacemeNT raTINgs Reflects a hospital’s performance in surgical aortic valve replacement. Does not include data for trans-catheter aortic valve replacement, though the sts has started to collect it. Overall score is a composite of two measures: survival (per-centage of patients who leave the hospital and survive at least 30 days after surgery) and complications (percentage of patients who avoid the most serious complications, which are the same as for bypass).

all data were adjusted based on the health of patients. still, limitations of such adjust-ments can make direct comparisons difficult.

mOre INfOrmaTION For details on our methodology, go to ConsumerReports.org/cro/ howweratehospitals. For our complete hospital Ratings, subscribers to our website can go to ConsumerReports.org/hospitalratings.

If your hospital is not in our Ratings, you can help change that. Contact your surgeon, the head of the hospital’s cardiac department, and the hospital’s CEO. Say that they should report their heart data to the Society of Tho-racic Surgeons and that they should let the STS share the data with us. In addition, join our Safe Patient Project (safepatientproject.org), which uses the power of thousands of patient advocates to push for safer hospitals and transparent medical information.

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