Transcript August 2010 - University of Louisville

Interim Joint Committee
on Health and Welfare
August 17, 2011
THANK YOU
Jewish Hospital &
St. Mary’s HealthCare
Jewish Hospital
HealthCare Services
Saint Joseph Health System
Catholic Health Initiatives
UMC
University of Louisville
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UOFL MILESTONES
1970 – State system – “another mouth”
1997 – Watershed event for UofL – HB1 –public agenda
• “Premier nationally recognized research university”
• Build new economic clusters/replace lost manufacturing
jobs
• Work to improve healthcare in Kentucky
This merger allows UofL to continue to achieve HB 1goals
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STARK REALITY!
University of Louisville has experienced
11 Budget cuts in 11 years
So, We (UofL) developed
Seven Strategies to Achieve our legislative mandate:
1.
Continuing re-engineering of processes and expense management
2.
Aggressively improving balance sheet management, with an emphasis on
converting underperforming assets
3.
Increasing contract research and commercialization income
4.
Creating private sector partnerships
5.
Enhanced fund raising
6.
Being creative in expanding the research mission through innovative financing
tools like the tax increment financing plan
7.
Increasing clinical income to support education and research
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WHY IS CLINICAL INCOME IMPORTANT TO OUR
TEACHING/RESEARCH MISSION
UofL School of Medicine Total Budget = $351 million
$28 million of total SOM budget is state appropriation
Generating clinical income is critical to supporting the
teaching and research mission of UofL
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While this merger is critical to UofL achieving the
legislative mandate you have given us neither
UofL nor the School of Medicine are merging!
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Who is merging?
UMC
(dba University Hospital/JGBCC)
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UMC WITH JHSMH & SJHS
A Quick History
1970 – UofL joins state higher education system
– 1970 – UofL joins state higher education system
– 1970-1983 – Medical education programs at Louisville General Hospital
– 1978 -- Construction of University Hospital begins
– 1983 – University Hospital opens, E0-83-102/Humana management contract to
operate University Hospital
– 1993 – Humana – Galen – Columbia – HCA
– 1995 – Mr. Scott announced move to Nashville
– 1996 – UMC created (Jewish/Norton/UL)
– Each member organization had veto authority over board action
(e.g. January ‘07 – July ‘07)
– 2007 – Norton/Jewish withdraw from UMC control hospital
– 2008 – Community based board created to govern UMC
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UMC
2008 – Strategic/financial 5 year plan
• Conclusions
• With large uninsured population (21%) UMC could not
continue to operate in the future as it was
– Cut uninsured care; and/or
– Cut clinical support to UofL SOM (which would result
in fewer services)
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OPTIONS CONSIDERED BY UMC BOARD
• Go alone
• Partnerships
– Private hospital chain (give up academic control)
– Norton
– Jewish
• Program areas (5)
• Two way merger
– Saint Joseph/CHI (Jan. 2010)
• 73 hospitals/19 states
• States with healthcare problems
• Commitment to Kentucky
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VISION STATEMENT
We are the premier, integrated comprehensive health system in
the Commonwealth known for efficiently providing the highest
quality care and service close to home; reducing the incidence of
disease; and eliminating inequities in access throughout the
communities we serve. With unmatched geographic reach, we are
differentiated by our faith based and academic heritage,
developing the best next generation of healthcare professionals,
and for being the fastest in translating research from bench to
bedside. Because we are the most vital nationally recognized
health system, we are the go-to organization for any major health
policy initiatives in the State.
JHHS/JHSMH/SJHS/CHI/UL/UMC
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Statewide Reach of Merged Hospital Systems
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THIS IS FIRST AND FOREMOST ABOUT BETTER
HEALTHCARE FOR KENTUCKY
(YOU KNOW OUR HEALTHCARE STATISTICS)
• It is also a financial transaction that allows us to achieve mandate
• Maintain current support
– UMC
– JHSMH
– Other
• $320M infusion of capital
– $200M for investment in the UofL academic medical center
– $120M for community and statewide program support
• $100M investment in EMR/IT
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WHAT HAPPENS IF WE DON’T MERGE
• UMC’s payor mix is unsustainable (21%)
• UMC and JHSMH for years have sacrificed much needed capital
reinvestment for facilities to fulfill their missions
• Inability of UMC to compete in market
– Neurosurgery
– Trauma Center
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GOVERNANCE OF MERGED ENTITY
Academic Medical
Center Committee
11 Individuals
7 – UofL
Merged Entity Governed
by a Community Board
18 Individuals
Diverse Board
Strong Board
Academic Affiliation Agreement
Defines relationship for UofL SOM & Merged Entity
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CURRENT UNIVERSITY OF LOUISVILLE
ACADEMIC AFFILIATION AGREEMENTS
Our faculty/physicians practice medicine at many hospitals and
clinics:
• UMC
• Norton Healthcare
• Louisville VA Medical Center
• JHSMH
• Baptist Health
• Kosair Children’s Hospital
• Trover Clinic
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FUTURE UNIVERSITY OF LOUISVILLE
ACADEMIC AFFILIATION AGREEMENTS
WILL BE WITH…
•
Merged Entity
•
Norton Healthcare
•
Kosair Children’s Hospital
•
Louisville VA Medical Center
•
Baptist Health
•
Trover Clinic
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Catholic Health Initiatives: Committed to Kentucky
• Saint Joseph Hospital founded in 1877
• Providing health care to the people of Kentucky regardless of their ability
to pay is at the heart of our mission
• Appalachian Outreach Program
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Catholic Health Initiatives: Committed to Kentucky
• CHI is committed, with our partners, to
– Increasing access to care
– Expanding services
– Enhancing clinical quality
– Preparing providers for the future
• CHI has invested nearly $1 BILLION in Kentucky health care
– Includes $320 M in capital infusion in the merged entity
• CHI National Office, Erlanger, KY since 2000
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• Innovative Partnerships
– University of Louisville
– Catholic Health Initiatives
• Expansion of the Academic Medical Center
• New health delivery system for the Commonwealth
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COMMUNITY BENEFIT/
CHARITY CARE
• Serving patients unable to pay is a hallmark of each merging entity's
mission
• All partners remain strongly committed to this profound responsibility to
the communities we serve
• Without merger, the ability of University of Louisville Hospital and JHSMH
to serve the indigent population will be severely jeopardized
• Combined community benefit in 2009 was $270 million among University
of Louisville Hospital, JHSMH and
Saint Joseph Health System
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WHAT ARE THE CLINICAL
IMPLICATIONS OF MERGER?
Sanctity of the doctor-patient relationship remains unchanged
• The agreements ensure the physician will be able to discuss with patients
the full array of clinical options to inform their decision making regardless
of where services are provided
Continued protection of academic freedom
• Agreements protect academic freedom and do not limit content curriculum
or location of university classes
Continued provision of care
• All institutions that are part of the merger will continue to provide care /
expand access to all regardless of their ability to pay
– All hospitals will continue to provide inpatient care as they do today,
consistent with their missions and non-profit status.
– UofL clinics not part of merger; will continue as they always have
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THE FACTS ABOUT MERGER
End of Life Care
• Advance Directives
– Physicians will continue to inform patients and families of all options
available, including palliative care, terminal sedation and Hospice care
– State law controls (KRS 311.621- 311.633); all hospitals will abide by
these statutes
– Can be honored consistent with ERDs with rare exceptions
Organ Donation
• No change – can be performed consistent with ERDs
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THE FACTS ABOUT MERGER
Reproductive Services
• Miscarriage management
– No change – treatment can be provided consistent with ERDs
• Ectopic Pregnancy
– No change- treatment can be provided consistent with ERDs
• Abortion
– Elective abortion
• No change-not performed at University Hospital today
– Medically indicated abortion
• No change – treatment can be provided consistent with ERDs
• Emergency Contraception
– No change-treatment can be provided consistent with ERDs
• Family Planning
– No change- will continue as an office procedure
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THE FACTS ABOUT MERGER
Reproductive Services
• Tubal Ligations
– Tubal ligation as a sole procedure will be performed in hospital
setting outside of merged entity
– Vaginal delivery and tubal ligation will be performed in hospital setting
outside of merged entity
– C-section and tubal ligation at one anesthesia will be performed in
hospital setting outside of merged entity
Note: State law requires 24 hours’ written informed consent (KRS 212.347)
• Vasectomy
– No change - will continue as an office procedure
• In Vitro Fertilization
– No change - will continue as an office procedure
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QUESTIONS?
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