Methodist Health Community Report - July 2023

Community Impact Report

July 2023

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Contents Introduction

Dedication to our Patients

• A Message from Dan Miller, President and CEO of Methodist Healthcare

• Pastoral Care

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12

• Charity Care • Our Commitment to Quality

• Our Mission, Vision and Values • The Power of Two • Who We Are

Supporting Our Colleagues

16

Investing In and Advancing Clinicians

• Health Equity Index (HEI) Designation

•M ethodist Healthcare Nursing Residency Programs

• Diversity, Equity, and Inclusion (DEI) • Colleague Networks • Being BRAVE • Community and Education Partnerships

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• Galen College of Nursing • Graduate Medical Education

Caring for our Communities

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• Supporting Local Causes • Community Health Needs Assessment and Community Health Priorities • Rowan Windham Cereal Drive • Crush the Crisis • Kids Teaching Kids • Car Seat Safety Day • HCA Hope Fund • Supporting Diverse Businesses

Looking to the Future

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Our Hospitals and Facilities

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• Methodist Hospital/Methodist Children’s Hospital • Methodist Hospital | Northeast • Methodist Hospital | Stone Oak • Methodist Hospital | Texsan • Methodist Hospital | Metropolitan • Methodist Hospital | Specialty and Transplant • Methodist Hospital | Atascosa SAHealth.com 5

Above: Dan Miller, President and CEO, Methodist Healthcare

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A Message from Dan Miller President and CEO of Methodist Healthcare Since opening our first hospital in 1963, Methodist Healthcare has provided quality care to residents of San Antonio and 27 surrounding counties and patients from around the world. For sixty years, it has been our privilege to support our communities and to ensure access to care for all, regardless of their ability to pay.

Though our community experienced many tragedies in 2022, Methodist Healthcare staff and physicians continued to uphold our sacred mission. Collectively, our facilities cared for over 402,000 patients and provided over $818 million in charity and indigent care to South Texans. The year also brought exceptional recognition of the outstanding patient care at Methodist Healthcare: • Six Methodist Healthcare hospitals were named among the prestigious Fortune / Merative 100 Top Hospitals® list.

• Methodist Hospital | Stone Oak was recognized by Newsweek as a Top 10 Rehabilitation Center in Texas.

• Methodist Hospital was named No. 1 Best Regional Hospital for 2022-2023 by U.S. News and World Report for the fourth year in a row, as well as being nationally ranked among America’s 250 best hospitals by Healthgrades.

• For a sixth consecutive year, Methodist Hospital | Metropolitan was named a “Leader in LGBTQ+ Healthcare Equality” by the Human Rights Campaign.

• Methodist Hospital | Northeast was voted Best Hospital for a third year in a row by San Antonio Express-News readers.

• Methodist Hospital | Atascosa received the coveted 5-star CMS rating.

This kind of success not only benefits our patients directly, but also improves the lives of communities most in need. Including the distribution of funds for our local co-owner, Methodist Healthcare Ministries (MHM). MHM was able to operate four clinics that supported over 352,000 patients in 2022. This year, MHM has allocated $149.9 million planned for community health efforts throughout South Texas.

Supporting our community went far beyond our hospital walls. After the historic shooting in Uvalde, Texas, many staff offered assistance to a town in mourning, often visiting Uvalde Memorial Hospital. Several chaplains visited and prayed with staff, nurses covered many shifts, and our EMS Relations Managers and dogs offered comfort to the hospital staff, police department, and community volunteers.

It is an honor to lead a compassionate team so committed to the well-being of the communities in South Texas. With the support of Methodist Healthcare Ministries and HCA Healthcare, our System will continue to provide the highest quality of care to all who need us.

God bless,

Dan Miller President and CEO Methodist Healthcare

• Methodist Hospital | Specialty and Transplant received its 10th consecutive “A” grade for patient safety and continues to have both the largest living donor kidney transplant program as well as Hispanic transplant program in the nation.

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Mission, Vision, Values Our Mission The mission of Methodist Healthcare is “Serving Humanity to Honor God by providing exceptional and cost-effective health care, accessible to all.”

Our Vision Our vision is to be a world-class health care provider, continually raising the standards of performance excellence and advancing the health status of the community by providing and constantly improving the delivery of quality, innovative health care services in a cost-effective way, while providing charitable care to people in our region.

Our Values In doing so, we acknowledge our values of Integrity, Compassion, Accountability, Respect and Excellence. On an individual basis, we commit to: • Cure when we can • Escort to death’s door when we must • Always create healing experiences

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The Power Of Two. This powerful partnership between the Methodist Healthcare Ministries and HCA has made an incredible impact in our community.

$1.4 Billion invested in the community over the past 10 years

$818 million

$796,700,000

in charity and indigent care in 2021

in total payroll

$21,569,017

$15,961,462

in property taxes

in sales taxes

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Who We Are Methodist Healthcare System (MHS) has evolved to meet the growing needs of the greater San Antonio community, and our commitment since opening our first hospital in 1963 has never wavered: to continuously improve the health and wellness of our community by “Serving Humanity to Honor God.” Formed in 1995 by Methodist Hospital’s Board of Trustees, Methodist Healthcare created a 50-50 partnership between Methodist Healthcare Ministries of South Texas Inc., South Texas’ largest nonpublic funding source of community health care for uninsured patients: and HCA Healthcare, the nation’s leading provider of health care services. This creates a unique avenue to ensure that Methodist Healthcare Ministries continues to benefit the community by providing quality care to all and charitable care when needed.

Methodist Healthcare Ministries is the largest private funding source for uninsured and underinsured patients in South Texas.

• Serving •

74 counties

$1.5 billion provided to the community since its inception to improve wellness among the least served through direct services, grants, and community partnerships

•

320 funded program sites

• Over

130 grant programs

• 4 clinics supporting •

352,000+ patients

HCA Healthcare is continually investing in colleagues and facilities to better serve patients and local communities.

•

given to HCA colleagues in 2022 •

$4.4M billion invested last year (2022) in

land, buildings and equipment to expand or bring new services to the communities served

320 GME

• More than programs making HCA Healthcare the largest graduate medical education provider in the country • In 2022, they increased their investment in

123,231 colleagues,

recruitment to help hire a 6% increase from 2021.

$149.9 million planned for 2023 for community health

$30.4M in tuition assistance benefits

•

$12M in assistance distributed in 2022 to

HCA Healthcare families through the Hope Fund

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Dedication to our Patients 12 2022 Community Impact Report

Pastoral Care

Methodist Healthcare System Chaplains

Methodist Healthcare has a team of chaplains dedicated to helping patients and their families deal with a health crisis, including specially trained chaplains for children, oncology patients, sexual assault survivors and critically ill patients. The chaplaincy program is considered a national benchmark for hospitals.

Charity Care As part of our mission, Methodist Healthcare provides care to patients without financial means to pay for hospital services. Services will be provided to all patients who present themselves for care at any Methodist Healthcare ER without regard to race, creed, color, or national origin and who are classified as financially or medically indigent.

Further eligibility and assistance information, a copy of our financial assistance policy, the financial assistance form and a listing of physicians who provide emergency or other medically necessary services at Methodist Healthcare facilities, including whether their services are available at the link below or by written request to the following address: Patient Accounting Services 15727 Anthem Parkway, Suite 101 San Antonio, TX 78249

340k Chaplain/ Patient Visits

$818 Charity Care Charges

24k+ Patients Helped through Charity Care

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Our Commitment to Quality We strive to deliver superior care to our patients during every interaction.

We continually look for ways to improve patient safety and quality of care.

One area of focus is improving the results/outcome in recognizing and treating patients who have sepsis, a serious condition in which the body responds improperly to an infection Sepsis care has been on a steady trend of improvement at Methodist Healthcare facilities for the past several years. Several factors have influenced this including an alert system, SPOT, which helps provide early identification of inpatients who may have sepsis. We are also piloting an alert in the emergency room to promote rapid completion of the necessary elements of sepsis care. Patients entering the emergency departments are quickly assessed by a clinician for signs and symptoms of sepsis (severe sepsis or septic shock), and appropriate lab tests are expedited so that antibiotic and fluids can be administered per the provider’s orders.

The greatest obstacle to survival is timely recognition – every hour of delayed diagnosis increases the chance of death by four to seven percent. SPOT (Sepsis Prediction and

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Optimization of Therapy), which uses the popular dog name because it sniffs out sepsis, is an algorithm and alert system for the early detection and treatment of sepsis. It is like a “smoke detector for sepsis”.

Unlike human capability, SPOT continuously monitors patient vital signs, lab results, nursing reports, and other data that signal impending sepsis. SPOT can alert nurses and doctors to the first signs of sepsis, hours before they would typically recognize the condition.

A SPOT alert is sent to care teams on their mobile devices within minutes of important and often undetectable changes in a patient’s condition so they can confirm its hypothesis and take appropriate action. If sepsis is not “ruled out,” treatment begins immediately.

SPOT runs 24/7/365 so patients are continuously monitored, enabling the early detection of sepsis and significantly increasing chances of patient survival.

We have seen quite an improvement in our sepsis mortality rates. Our sepsis mortality rate for 2021 was 10.6 percent and in 2022, our rate dropped to 8 percent versus the national average of 18.2 percent.

Our patients’ safety is our priority. Our goal is to make our patients feel safe and secure during their hospital stay.

We assure a standard of quality care through proactive, ongoing training for staff and credentialing processes for all of our physicians.

Every member of our staff is dedicated to: • Providing a safe, healthy and secure environment • Performing their jobs carefully and completely • Using safe and effective practices and technologies • Providing better quality care based on the unique needs of our international patients • Responding to the wants and needs of our patients in a timely manner • Ensuring timely communication between caregivers and patients by answering questions regarding treatment and health • Providing specific information about our patients’ care and explaining changes about their treatment

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Supporting Our Colleagues SAHealth.com 17

Diversity, Equity, and Inclusion (DEI)

Our commitment to DEI continues as we provide an inclusive environment where our employees feel they have a sense of belonging and can be their authentic selves. We strive to create and maintain a setting in which we celebrate differences and consider them strengths of the organization. Our work includes our commitment to patients, colleagues, suppliers and the community.

HEI Designation The staff and physicians have helped Methodist Hospital | Metropolitan earn the status of “Leader in LGBTQ+ Healthcare Equality” by the Human Rights Campaign Foundation (HRC), for six consecutive years in a row. The HRC is the education arm of the country’s largest LGBTQ+ civil rights organization. Methodist Hospital | Metropolitan Is the only hospital in San Antonio to earn this designation, with a total of only four in the state of Texas.

Colleague Networks In 2022 we stood up six Colleague Networks to help foster an engaged and inclusive culture.

Our Networks provide a safe space for employees to feel they belong. These Networks create imitatives focused on networking, professional development and community service. These leaders came together to establish goals, host events and prepare communication displaying strong leadership skills.

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2022 Colleague Network Groups: • Asian and Pacific Islander Colleague Network • Black Colleague Network • Women’s Colleague Network • LGBTQ+ Colleague Network • Hispanic Colleague Network • Young Professionals Colleague Network • Veteran’s Colleague Network

Being BRAVE In 2022 we held four Brave Conversations with members of our Division DEI Council and Colleague Networks. BRAVE stands for Bold, Relevant, Authentic, Valuable and Educational. Each conversation focused on their shared experience of being a part of a certain group. We held conversations as part of Women’s History, Pride, Hispanic Heritage Month and Veterans Day. With roughly 100 leaders in attendance at each session, we received great feedback about the impact.

Supporting Diverse Businesses Not only is Diversity something we strive for in hiring and patient care, we also work hard to support diverse businesses when purchasing supplies our facilities need.

Did you know we spent:

$24,388,070

with Minority Owned Businesses

$21,133,921

with Women Owned Businesses

$1,929,455

with Veteran Owned Businesses

Community and Education Partnerships Partnering with our Community is a critical part of our DEI work. In 2022 we established seven new partnerships with key non-profit partners to help advance the work of our Colleague Networks. These organizations are committed to helping marginalized populations in our San Antonio area. We supported these organizations by volunteering and providing sponsorships throughout the year.

Methodist Healthcare is committed to the development of a workforce that mirrors our city.

We feel the earlier exposure to healthcare careers, the better. In 2022 we established seven new partnerships with high schools hosting onsite hiring and volunteer recruitment events on their campuses.

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Investing In and Advancing Clinicians SAHealth.com 21

Methodist Healthcare Nursing Residency Programs Methodist Healthcare Nursing Residency Program, StaRN, consists of intensive structured specialty orientation designed to support transition of the graduate registered nurse to bedside nursing practice in a specific clinical setting.

The paid 10-22 week program is designed for nurses with little or no acute care experience and includes comprehensive didactic training, a robust simulation experience with debriefs, clinical preceptorship, as well as BLS, ACLE, NIGH Stroke Scale, ECG and CPI certifications. Each Nursing Residency specialty focuses on development and verification of proficiency in key entry level technical, interpersonal and critical thinking skills required for safe practice. Nurse Residents are introduced to the Methodist Healthcare mission, interact with members of the health care team and acquire knowledge of regulatory requirements related to clinical practice in an acute care setting.

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Galen College of Nursing Galen College of Nursing has been a proud member of the San Antonio nursing education community since the Texas Board of Nursing approved Galen’s Vocational Nurse program in 1990. In 2015, Galen opened its doors to a newly expanded and renovated San Antonio campus, featuring high-level clinical learning labs, as well as a simulation ER, ICU, and Pediatric units. They now have two locations in San Antonio totaling 111,182 square feet of teaching and training space. Today, Galen is one of the largest nursing educators in South Texas, offering students a cutting-edge approach to nursing education, and graduating hundreds of future nurses each year from their 3-year BSN, VN, and LVN to ADN Bridge programs.

“With partners like Methodist Healthcare, we are so proud to help serve the San Antonio community by graduating confident, wellprepared, and compassionate nurses,” explained the Dean of the San Antonio campus, Terry Douglas, DPN, RN. “For over 30 years, we have been deeply embedded in South Texas to help address the critical nursing shortage and provide better care to our citizens.”

HCA Healthcare’s tuition assistance program includes the HCA Healthcare – Galen College of Nursing Grant, which allows direct billing between our two organizations. That means zero out-of-pocket tuition costs for colleagues pursuing their nursing education.

9,913 Galen graduates since 2008

Graduate Medical Education Methodist Healthcare System of San Antonio (MHS) Graduate Medical Education (GME) provides clinical rotation opportunities for affiliated training institutions accredited residency, fellowship, Medical and Physician Assistant (PA) student programs. We are proud of the clinical experience gained at our facilities.

For the 2021-2022 academic year, there were 40 programs from 35 various specialties.

A total of 522 visiting residents and fellows participated in clinical rotations at a Methodist Healthcare facility.

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Caring for our Communities SAHealth.com 25

Supporting Local Causes As Methodist Healthcare, we are proud to offer support to a variety of worthy causes. For 59 years, Methodist Healthcare has given back to the community through charitable donations, sponsorships and volunteering. As the most preferred health care provider in San Antonio, we are advocates for the advancement of the community.

Our Methodist Healthcare employees also provide support and funding to hundreds of non-profit organizations of their choice, through an online giving portal. The portal also allows staff to search for volunteer opportunities throughout our community.

Partnerships Methodist Healthcare supports a variety of worthy causes through annual agreements with likeminded organizations. Sharing an enduring purpose to improve the health of our community, our relationships are based on mutual values, goals, and an advocacy for the wellbeing of our area families.

Community Health Needs Assessment and Community Health Priorities As part of our commitment to the greater San Antonio community, Methodist Healthcare participates in a county-wide health needs assessment every three years. This assessment is conducted through the Health Collaborative, a non-profit convening organization that brings together hospital systems, other health care organizations, local government and non-profit organizations in Bexar

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County and Atascosa County to identify and solve community health issues through collaboration. Methodist Healthcare is proud to be a founding member of the Health Collaborative.

In order to work in coordination with other health care systems and organizations, businesses and non-profits, Methodist Healthcare has adopted the five health priority areas based upon the Bexar County community health assessment, the Bexar County community health improvement plan and the SA2020 goals. Methodist Healthcare and its hospitals have created community improvement plans based on these five health priorities so we may better serve you and the greater San Antonio community.

Community Health Priorities 1. Healthy Eating and Active Living 2. Healthy Child and Family Development 3. Safe Communities 4. Behavioral and Mental Well-Being 5. Sexual Health Access to the Community Health Needs Assessment (CHNA) and each facility’s Community Health Implementation Plan (CHIP) can be found by visiting: SAHealth.com/about/mission-values/charity-care.dot

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Rowan Windham Cereal Drive

258,221 serving of cereal to the San Antonio Foodbank

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Every year, in early June the lobby of our Methodist Children’s Hospital is filled to the brim with boxes of cereal signifying another successful Rowan Windham Memorial Cereal Drive. In an effort to kick summertime childhood hunger in Bexar County and surrounding communities, staff, along with members of the San Antonio community donated a total 258,221 servings of cereal to the San Antonio Foodbank for children in need.

Crush the Crisis In October, Methodist Healthcare hosted our 4th annual Crush the Crisis event. Aligned with the DEA’s Drug Take Back Day, we set up medication collections sites at three of our free-standing ERs: Alamo Heights, Nacogdoches, and Legacy Trails. Staff, alongside San Antonio Police Department officers, spent the morning collecting unneeded and/or expired medications. Across the three locations, we collected 1,361 lbs.! Many community members we spoke with were grateful to safely dispose of the medications they no longer needed. The goal of the event is to remove drugs from people’s houses where they could be misused.

Kids Teaching Kids We entered our second year hosting this program that focuses on teaching kids how to make healthy snack choices. Kids Teaching Kids revolves around a 21-Day Healthy Snack Challenge aimed at elementary school students. We had over 1,500 local students sign up to participate.

Nine local high school culinary programs also competed to come up with the best healthy snack recipe to be included in a recipe book that all 21-day challenge participants received.

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Car Seat Safety Day During the month of September, we celebrate Car Seat Safety. In 2022, we partnered with Methodist Healthcare Ministries, the Bluebird Auxiliary, and Safe Kids during National Car Seat Safety Week to provide free installations and car seat checks to over 50 families, and gave away 17 free car seats to those who needed them.

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Victoria Molina, RN Methodist Hospital, HCA Hope Fund Recipient

Scan here to watch Victoria’s story

HCA Hope Fund Our employees’ first goal is to take care of patients. Methodist Healthcare is also a family of co‑workers, and so we take care of each other.

The HCA Hope Fund was formed more than 15 years ago in the wake of devastating Florida hurricanes so employees around the country who are in need – and those who want to help – have a single, reliable source to give and receive assistance.

The well-named HCA Hope Fund has offered just that – hope. Its support has helped employees who have suffered everything from loss due to hurricane, tornado or fire to those dealing with unexpected catastrophic illness or accident. The fund also steps up to aid employees who are dealing with domestic violence, death of a loved one or other special situations. Since its inception, it has helped more than 45,000 families through contributions of $80 million is assistance.

In 2022 the HCA Hope Fund provided a total of $580,000 in support to 212 San Antonio division employees

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Looking to the Future We are happy to announce that Methodist Healthcare is growing in three different areas of our community: Methodist ER | City Base *Now Open* • 6,300 sq. ft, 7 room Free-Standing ER including full lab, pharmacy, and imaging suites to serve the Brooks City Base community

Methodist Hospital| Landmark This cutting-edge 150,000 square foot facility, nestled in the vibrant Northwest San Antonio community, is set to redefine surgical services and raise the bar for patient-centered care. Boasting 54 beds and staffed by an exceptional team of highly skilled physicians, Methodist Hospital Landmark stands as a beacon of excellence in surgical services. Key service lines include: • Breast Cancer Reconstruction

• General Surgery

• Bariatrics

• Neurology/Spine Care

• Orthopedics

• Urology

• Gyn Oncology

• Cardiology

• Colorectal

Methodist Hospital | Westover Hills The Methodist Hospital | Westover Hills will be approximately 180,000 square feet, with 54-beds, offering acute care designed to create access for the Westover Hill Community. Key service lines: • Emergency Care

• Cardiology

• Surgery, Gastrointestinal

• Maternity and NICU

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Our Facilities Methodist Hospital/Methodist Children’s Hospital • Named Best Regional Hospital fourth consecutive year by U.S News and World Report • First hospital in the world to treat patients on ECMO with Next-Generation Technology • Opened the Diabetic Foot and Ankle Institute to combat alarming Bexar County amputation rates • Methodist Hospital expands access to cancer care with a new rehabilitation center specifically for cancer patients

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Methodist Hospital | Northeast • Received Joint Commission certifications in: Primary Stroke Center, Joint: Hips and Knees, and Stroke Rehabilitation • Awarded Best Hospital in San Antonio for 2021 & 2022 by the SA Express-News Reader’s Choice Awards • Opened a state-of-the-art Hybrid Operating room to increase imaging capabilities with a fully functioning operating suite

Methodist Hospital | Stone Oak • Recognized by Newsweek as a Top 10 Rehabilitation Center in Texas • Recertified as an Advanced Primary Stroke Center by The Joint Commission • Acquired Stone Oak Surgery Center in an effort to expand capacity to care for surgical patients in the community

Methodist Hospital | Texsan • Designated as a HeartCARE Center for the fourth year in a row • Renewed The Joint Commission’s Gold Seal of Approval for Disease-Specific Care Certification of Total Hip and Knee Joint Replacement • There were 389 total knee replacements and 140 total hip replacements at Texsan in 2022, a 14% increase from the previous year

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Methodist Hospital | Metropolitan • Opened a Cardiovascular Rehabilitation Program • Redesignated as a Certified Quality Breast Center of Excellence – Clinical Level. The hospital has held the highest level of this designation since 2018 and is the only ”Clinical” Certified Quality Breast Center of Excellence in Texas • For a sixth consecutive year, the hospital was named a “Leader in LGBTQ+ Healthcare Equality” by the Human Rights Campaign

Methodist Hospital | Specialty and Transplant • Received 10th consecutive “A” grade for patient safety • Since its inception in 2001, the liver disease program has continually ranked in the top decile in the U.S. The program is one of fewer than 100 in the U.S. to earn certification from both Medicare and Medicaid – the highest quality indicator for a transplant program • In 2022, the Methodist Transplant Institute completed 171 living donor kidney transplants and 171 deceased donor kidney transplants. The program was recognized as the largest living donor kidney transplant program and the largest Hispanic kidney transplant program in the nation.

Methodist Hospital | Atascosa • Received an “A” Leapfrog Hospital Safety Grade for the 9th consecutive time • Opened a new and improved Sleep Center • Received a 5-star CMS Rating

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Hospitals 1. Methodist Hospital/Methodist Children’s Hospital 2. Methodist Hospital | Northeast 3. Methodist Hospital | Stone Oak 4. Methodist Hospital | Texsan 5. Methodist Hospital | Metropolitan 6. Methodist Hospital | Specialty and Transplant 7. Methodist Hospital | Atascosa 8. Methodist Hospital| Landmark (Opening Summer 2023) 9 . Methodist Hospital | Westover Hills (Opening 2024)

Freestanding Emergency Rooms 10. Methodist ER | City Base 11. Methodist ER | Boerne 12. Methodist ER | Converse 13. Methodist ER | Alamo Heights 14. Methodist ER | De Zavala Rd. 15. Methodist ER | Legacy Trails 16. Methodist ER | Nacogdoches Rd. 17. Methodist ER | Helotes

Urgent Care Centers 18. CareNow Urgent Care – Bulverde Rd. 19. CareNow Urgent Care – De Zavala 20. CareNow Urgent Care – Alamo Heights 21. CareNow Urgent Care - Potranco 22. CareNow Urgent Care – Leon Valley 23. CareNow Urgent Care – Stone Oak

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Methodist Hospital Landmark (Opening Summer 2023)

Methodist Hospital Westover HIlls (Opening 2024)