Questions posed by MMC Volunteer Organization's Board of Directors & MMCF Board

1. When will the surgical robot arrive and be operational for patient care?
   It may be possible to accept delivery by the end of this year. We then would be operational in early 2007.

2. Clarify the pledge payment timeline?
   The timeline is five years beginning in 2007 with flexibility for the amount paid each year. For example, a bill was recently passed by Congress and signed by the President which provides a two year opportunity allowing those aged 70 ½ and older to make contributions from their IRA's of amounts up to $100,000 free of any income tax. In this case, the first two years may have larger donations than the last three years.

3. Are there any other vendors for this particular technology?
   No, Intuitive Surgical is the only vendor for surgical robots.

4. Where did the technology begin?
   It began in California in the late 1980's as part of a defense contract.

5. Are there any other hospitals in our region with this technology?
   Fort Sanders Regional Medical Center acquired the first one in our region in 2005, and St. Mary's recently obtained one. We fully expect within the next few years that all major medical centers in our region will be actively using surgical robotics.

6. Because of its cost, is it practical for every hospital to have this technology?
   This technology is emerging as a surgical standard in medical schools across the country. Additional procedures will be added to those already available. It is essential for us to offer this leading edge surgical capability to our technology savvy patients, and to keep and recruit the best surgeons. If we do not have this technology, patients will have to go elsewhere to obtain these services.

7. Will this technology attract additional surgeons?
   Yes, it is the tool of choice for the very best surgeons, with gynecological surgery as our most likely addition in the near future. Today's surgical residents are training on the robot, and they want to practice in hospitals that have this technology.

8. What determines how quickly we can access this technology?
   The purchase date of this equipment will depend on the success of the campaign. The campaign goal is $1,250,000 which will pay for most of surgical robot's costs. Methodist Medical Center will provide the balance. We need to obtain at least ¾ of the cost in pledges to proceed with purchasing plans. At that point it will take a few more months to obtain the robot, get staff trained and begin taking care of patients.

9. What kind of surgeries will be performed with the robot and what is it future projected use? How many surgeons have indicated an interest in using it?
   To date, tens of thousands of procedures including general, urologic, gynecologic, thoracoscopic, and thoracoscopically-assisted cardiotomy procedures have been performed using the surgical robot. Surgeons coming out of medical school want to go to hospitals that have this technology. Some of our physicians are already using it, but they have to take their patients to another facility in order to obtain the benefits of robotic surgery.

10. Is the surgical robot being taught in surgery residency programs as the standard of surgical care?
    Yes, robotic surgery is going to be the standard of surgical care for the next several years. Graduating students expect to work at hospitals with this technology.

11. Hospitals seem to be making a lot of money. Why can't you just pay for this technology from your profits?
    Finances in the health care field are difficult because of low reimbursement and TennCare issues. Our bottom line and those of other Tennessee hospitals is facing increased pressure. We could eventually come up with the resources to pay for this robot but it would be several years from now and even then, given additional pressures by reductions in reimbursements, we may not be able to obtain one at that time. Plus, we have to continually balance the needs of the entire hospital and allocate scarce resources accordingly.

12. The hospital just spent a lot of money renovating and expanding its physical plant. Why can't it just pay for the surgical robot from its capital budget?
    Since we are a part of Covenant Health, we go through a lengthy capital budget process. Given the $47 million Covenant recently spent on renovating and expanding our hospital, it would be several years before we could obtain the surgical robot through the regular capital process. The campaign allows us to get this latest technology now rather than later.

13. Is MMC a non-profit organization?
    Yes, MMC has 501(c) 3 status which identifies it as a non-profit organization. All contributions to the campaign are deductible to the extent of current law.

14. Why do we need the surgical robot?
    This technology is and will continue to be the standard of surgical care for the next decade. It will bring increased patient satisfaction and attract new patients, help patients return to work sooner, increase physician referrals, recruit and retain top surgical talent, and enhance hospital reputation.

15. What is the shelf life of the surgical robot? Will it become obsolete before I can finish paying off my pledge?
    Just like any piece of technology, the surgical robot will be upgraded from time to time. Intuitive Surgical is constantly researching and looking for ways to make this equipment better. We fully expect that the surgical robot will be the standard of surgical care for much longer than the pledge timeline.

16. Is it just a pet tool for some of the hospital's medical staff or will it have broader usage?
    The robot is a practical tool not an elitist tool. This technology can be used in many different surgical specialties to help a broadening base of patients. It will also bring more business to other hospital services such as radiology.

17. If we wait longer, will we get it cheaper?
    No, because the surgical robot will continually be upgraded to perform at the highest level, and as such, we expect the cost will remain approximately the same. Since Intuitive Surgical is currently the sole vendor, it is unlikely the price would be reduced any time soon.

18. How many people that live within our area may have need for this surgical robot?
    Methodist serves a wide geographic area and serves a population base of over 200,000. Since this surgical robot can be used for so many different specialties, it will be needed by many. One example of increased need is prostate surgery. As the population of our society ages, more men will need this procedure.
19. Where is the Intuitive Surgical Robotic System being used now?
    Currently, surgical robots are being used at major centers in the United States, Austria, Belgium, Canada, Denmark, France, Germany, Italy, India, Japan, the Netherlands, Romania, Saudi Arabia, Singapore, Sweden, Switzerland, United Kingdom, and Australia.

20. Will this technology make the surgeon unnecessary?
    On the contrary, robotic surgery enables surgeons to be more precise, advancing their technique and enhancing their capability in performing complex minimally invasive surgery. The physician's movements are replicated in real time. The robot cannot be programmed, nor can it make decisions on its own to perform any type of surgical maneuver without the surgeon's input.

21. What are the benefits of using robotic surgery over traditional surgery methods?
    Some of the major benefits experienced by surgeons using the robotic surgery have been greater surgical precision, increased range of motion, improved dexterity, enhanced visualization and improved access. Benefits experienced by patients may include a shorter hospital stay, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery and a quicker return to normal daily activities. The quicker recovery also benefits their family, businesses, and others in the community.

22. Will I pay more for a robotically-assisted surgery over a traditional type surgery?
    No. A hospital is reimbursed a set amount of money per surgery regardless of whether it is performed using the robot or traditional methods. Insurance carriers, including Medicare and TennCare, pay hospitals a standard reimbursement rate for every procedure. For commercial insurance companies these rates are negotiated but are based on the reimbursement formulas mandated by the government.

23. What if you raise more than the $1.25 million needed for the purchase price of the robot?
    That would be a wonderful problem to have! And, if we do go above and beyond our goal, the additional contributions will be earmarked for additional features and future upgrades to the technology.