Transcript Slide 1

Securing the Future of the State’s Public
Academic Health Center
Clinical Facilities Planning at
John Dempsey Hospital
Higher Education and Employment
Advancement Committee
March 8, 2007
1
We come to you with a plan for a new replacement hospital which will
assure the future of the state’s only public academic health center
We propose to enable this plan through:
1) Reallocation of our existing UCONN2000 funding
2) The state’s help in securing favorable borrowing rates in order to limit the
financing costs we will repay AND because the University and its hospital
are state assets, state backing would have a public cost benefit
3) Repayment of all bonded indebtedness from the new revenues we will
generate from the hospital and from donations
4) No additional state funding is required for the project as proposed
5) These actions would not establish a new hospital; rather, they would
enable JDH to move forward with OHCA’s standard Certificate of Need
process, which cannot be undertaken without a financing plan.
2
UCHC’S Primary Mission: Education and Research
•
3 Schools:
– Medical School (320 students)
– Dental School (160 students)
– Graduate School in bio-medical sciences (380 students)
•
Research: More than $90 million per year of innovative research is conducted and
discoveries are translated into advances in patient care e.g. cancer vaccines,
hormone therapies for Osteoporosis, new materials for Dental Implants, and Stem
Cell research.
•
Residency Training: For approx 600 residents/year who train in local hospitals
•
John Dempsey Hospital (JDH) and UConn Medical Group (UMG), the multi-specialty
faculty practice, are sites for learning and represent key elements in attracting
talented faculty who want to teach, do research and provide patient care.
(Time/reimbursement pressures mean that fewer community physicians now give
time to teaching.)
3
UCHC: Separate Components But one Vital System
Prediction,
S
I
G
N
A
T
U
R
E
P
R
O
G
R
A
M
S
Prevention & Health
Promotion Portal
Tertiary → Secondary → Primary Care
BENCH
BEDSIDE
COMMUNITY
HEALTH
CARE
C4I
C4I
T1 Research
Musculoskeletal
Public Health Research
and Practice
Undergrad
Graduate
Cancer
Cardiology
T2 Research
POPULATION
HEALTH
E
D
U
C
A
T
I
O
N
Biostatistics
Center
GCRC
Health
Services
Research Unit
HPPCRC
Research
Methods
Core
Continuing
CHIN
Connecticut
Health
BEHAVIORAL / EDUCATION RESEARCH
UCHC: Separate Components But one Vital System
•
UCHC must maintain a productive core of full-time faculty
committed to our academic mission
•
UCHC needs to grow its full time faculty base to stabilize and
enhance its education programs
– UCHC has a smaller faculty size compared to other regional
schools
•
We must be competitive in attracting faculty. Medical faculty
want to be where:
– Their teaching is highly valued
– Their research is enabled
– And they can practice close to their teaching and their
research
5
UCHC: A Resource to the Community and the State
•
Service to Medicaid Patients
•
•
•
Clinical Service Collaboration:
•
•
Among the top 5 hospitals in state in Medicaid inpatient days as a percentage of total
inpatient days
Largest single provider of dental services to Medicaid clients and the under-and
un-insured
• 61% of patient visits to the UCHC dental clinic in Farmington are Medicaid clients
• 70% of all student/intern/resident dental care activity is service to Medicaid
clients
Department of Public Health, Department of Correction, Department of Mental Health &
Addiction Services, Department of Veteran Affairs (Rocky Hill), Department of Mental
Retardation
Community Service:
•
•
•
•
•
•
•
South Park Inn Medical Clinic (Hartford)
South Marshall Street Homeless Clinic (Hartford)
Connecticut Poison Control Center
YMCA Adolescent Girls Medical Clinic (Hartford)
Camp Courant Dental Screening Program
Migrant Worker Clinic
Covenant House (Willimantic)
6
UCHC: A Resource to Other Hospitals
•
Trained physicians and staff of Waterbury and St. Mary’s for regional cardiac
surgery and interventional cardiology program.
•
Trained staff and assisted ECHN in establishing a Level II nursery at
Manchester Hospital.
•
Pediatric dentistry program at CCMC.
•
Statewide Neonatal Transport Program and Regional Neonatal Intensive Care
Unit. In the past 18 months, premature babies came to JDH from 109
Connecticut towns.
•
Provide workforce at Burgdorf Clinic.
•
Provide cardiac perfusionist services to St. Mary’s and Waterbury Hospitals.
•
Regional dental emergency room service.
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Training site for nursing, allied health schools.
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About John Dempsey Hospital (JDH):
•
Opened in 1975, JDH is the only public university acute care hospital in
Connecticut and the 2nd smallest academic health center hospital in the United
States.
•
Originally planned at 400 beds, the first phase of JDH was built at 200 beds.
The second tower was never built.
•
Has 224 fully staffed and licensed beds, of which 116 are very specialized
(Neonatal,Prison, Psychiatry, Maternity), leaving only 108 medical/surgical
(flexible) beds.
•
Receives no state general fund support for operations or capital program.
•
Faces the same set of challenges as the state’s other 29 acute care hospitals:
Medicaid/Medicare cutbacks, uncompensated care, low reimbursement rates,
nursing and other health care profession shortages and the realities of an
intensely competitive marketplace.
•
16.2% of JDH inpatient cases are Medicaid recipients. JDH is in the top five
hospitals in Connecticut for Medicaid inpatient days as a percentage of total
inpatient days. JDH is a disproportionate share hospital for Medicaid and
Medicare.
8
JDH Physical Plant Status:
•
•
30-year-old facility with no major upgrades since it opened
Undersized and becoming increasingly outdated
– Inadequate to accommodate today’s evolving standards of care and
technologies, privacy concerns, and patient/ provider expectations,
including operating rooms, inpatient rooms, neonatal intensive care unit,
outpatient diagnostic and treatment areas and support spaces
– Present design precludes efficient staffing ratios (32-bed units) or costeffective renovation
– Almost no remaining capacity to accommodate steady increase in
admissions, patient days, occupancy rates, as well as emergency room
visits, radiology and rehab visits
– Demand for service will outstrip capacity by 2008.
*
Used outside experts to analyze financials, design and demand; Based on outside expert
analysis regarding health care utilization and demographic trends in the region and statewide,
9
there is a need for 158 additional beds in the region by 2014.
JOHN DEMPSEY HOSPITAL
ADMISSIONS BY FISCAL YEAR
JOHN DEMPSEY HOSPITAL
AVERAGE DAILY CENSUS BY FISCAL YEAR
11000
4.15%
5.22%
10000
4.20%
14.13%
9000
9845
9826
10234
3.81%
10200
170
9407
162.1
165.0
158.3
160
152.8
150
8.59%
6.07%
167.0
166.7
8940
8580
8000
7000
4.66%
-0.19%
147.3
141.5
7518
140
136.2
6923
130
120
6000
FY
2000
FY 2000 FY 2001 FY 2002FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY2007
Projected Budget
JOHN DEMPSEY HOSPITAL
OUTPATIENT VISITS BY FISCAL YEAR
115000
FY
2002
FY
2004
FY
2006
Fy
2007
Budget
DENTAL CLINICS
PATIENT VISITS BY FISCAL YEAR
3 2 50 0 0
5.58%
5.93%
15.90%
270200
6.38%
255909
11.82%
95000
241582
2 50 0 0 0
20.38% 227099
21.63%
1750 0 0
105000
280000
6.06%
140588
-1.34%
203099
168720
5.53%
85000
8.64%
0.68%
76820
77340
81615
2.12%
3.94%
86625
6.86%
1.13%
92569
93611
-1.72%
5.87%
98000
92000
83343
75000
138711
65000
10 0 0 0 0
FY 2000FY 2001 FY 2002FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2007
Projected Budget
55000
FY 2000FY 2001FY 2002FY 2003FY 2004FY 2005FY 2006FY 2007FY 2007
ProjectedBudget
John Dempsey Hospital/Dental Clinics
EXPENSE PER ADJUSTED DISCHARGE BY
FISCAL YEAR
John Dempsey Hospital/Dental Clinics
TOTAL REVENUE PER ADJUSTED DISCHARGE BY
FISCAL YEAR
13000
-0.66%
13000
12000
11000
-1.97%
10,793
2.72%
11,087 -3.43%
10,708
2.93%
11,022
1.51%
11,188
5.50%
11,804
3.40%
12,206
12,055
-0.93%
12,092
-10.07%
10,977
5.04%
-3.98%
3.22%
11,575
-8.20%
11000
10,626
1.61%
10,797
1.64%
11,898
2.52%
-2.70%
11,869
11,577
11,327
10,974
10000
9000
FY
2000
FY
2001
FY
2002
FY
2003
FY
2004
FY
2005
FY
2006
FY
FY
2007 2007
YTD Budget
9000
FY
2000
FY
2001
FY
2002
FY
2003
FY
2004
FY
2005
FY
2006
FY
FY
2007 2007
YTD Budget
UConn Medical Group
VOLUME BY FISCAL YEAR (Unique Patient Visits)
John Dempsey Hospital
FTE's Per Adjusted Occupied Bed by Fiscal Year
5. 4
5.29
5. 2
600000
5.80% 7.48%
541,568
1
.33%
537,429
0.82%
23.79% -0.02% 1.78%
503,859 507,967
497,236
488,622 488,541
5.11
4.96
5
4.79
4 .8
4.69
4.66
500000
4.68
9.53%
4.56
4 .6
4.42
400000
4 .4
5.67% 394,706
360,360
4 .2
300000
4
3 .8
3 .6
FY 2000
FY 2001
FY 2002
FY 2003
FY 2004
FY 2005
FY 2006
FY 2007
YTD
FY 2007
Budget
200000
FY 2000 FY 2001 FY 2002FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2007
Project ed Budget
What We Propose:
•
•
Construction of a new University hospital to ensure continued provision of
medical/dental professionals to the region and the state, and to meet the growing
demand and changing demographics of the Farmington Valley
A new six story, 546,000 square foot facility with:
–
–
•
New operating suites, neonatal intensive care units, maternity, emergency department and
radiology, lobby/entry and parking spaces
352 beds (128 net new beds)
Financing construction primarily with bonds to be repaid by the UConn Health Center
through hospital revenues, not by the state
New Construction Will:
•
•
•
•
•
Attract/retain high quality faculty, physicians and other health professionals to the region and state,
and strengthen the Schools of Medicine and Dental Medicine, and our intern and residency
programs
Enable JDH physicians, nurses and other healthcare providers to continue providing the most
advanced care available in the most efficient setting possible
Allow JDH to meet growing demand for services, especially for aging populations in our key
Signature Program areas: cancer, musculoskeletal, cardiology and public health
Expand programs (such as bone oncology, the clinical trials network) that support other
Connecticut hospitals and health clinics, allowing Connecticut residents to stay in our state for top
quality, leading edge care
Create over 300 new jobs at JDH and, during the construction phase, stimulate the region’s
economy through the creation of construction jobs
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EXISTING
ARB
EXISTING
NEW CONSTRUCTION
BUILDING 'C'
HOSPITAL
P
MECH
MECH
7
RESEARCH
RESEARCH
6
RESEARCH
5
RESEARCH
MECH
4
RESEARCH
3
RESEARCH
MECH
RESEARCH
SUPPORT
BEDS-32
RESEARCH
BEDS-32
SUPPORT
BEDS-32
RESEARCH
BEDS-32
SUPPORT
BEDS-32
RESEARCH
2
RESEARCH
BEDS-32
SUPPORT
BEDS-32
CARDIOLOGY CENTER /
PHARMACY/ CATH LABS / LABS
1
RESEARCH
BEDS-32
SUPPORT
BEDS-32
DENTAL CLINICS
RESEARCH
BEDS-32
LOBBY /
SUPPORT
BEDS-32
CANCER CENTER
RESEARCH
SUPPORT
RESEARCH
M
G
B
SB
RESEARCH
RESEARCH /
LOBBY
OR / ED / RADIOLOGY
PARKING
MECH
RESEARCH
MECH
13
Total Beds
352
MECH
14
Fiscal Assumptions:
• 352 beds
• A preliminary project cost estimate of $495 million exclusive of
financing
• Bonds backed (but not paid for) by the state
• Bonds to be repaid with UCHC clinical revenues
• Current interest rate estimate of 4.75% (with state backing)
• Legislative designation as a named project in UCONN 2000 to
enable possible reallocation of $45 million within existing
annual and aggregate limits under the law
• Philanthropic contributions of $20 to $25 million
15
Financial Challenges Unique to JDH
• A more complex delivery system due to the education and research
functions of an academic medical center.
• Using its profit margin to support the medical and dental schools ($19.3
million over the past 5 years) rather than reinvesting in capital plant.
• Paying state fringe benefit rates. (In 2005, that rate was 38.7%, far higher than
the CHA member hospital average of 27.4%. The dollar value of the
difference between those rates was $8.1 million in 2005 alone. The ’07 state
rate is 40.9%, estimated to cost $10.5 million more than the average hospital
rate.
• Underwriting certain unprofitable essential health services because of its
public mission. Examples:
• Department of Corrections inpatient services
• Higher percentage of inpatient psychiatry beds
• Department of Mental Retardation dental services
• Among the top 5 hospitals in the state in Medicaid inpatient days as a
percentage of total patient days
16
Necessary Legislative Action:
•
We would request that the General Assembly designate the new
university teaching hospital a named project under the UCONN 2000
program.
•
We would request that the state permit a financing structure to enable
us to secure favorable borrowing rates and limit financing costs. This
might include state issuance or guarantee (with the State Treasurer) of
the bonds. Because the University and its hospital are state assets,
state backing would have a public cost benefit. No additional state
funding is required for the project as proposed.
•
These actions would not establish a new hospital; rather, they would
enable JDH to move forward with OHCA’s standard Certificate of Need
process, which cannot be undertaken without a financing plan.
17
We come to you with a plan for a new replacement hospital which will
assure the future of the state’s only public academic health center
We propose to enable this plan through:
1) Reallocation of our existing UCONN2000 funding
2) The state’s help in securing favorable borrowing rates in order to limit the
financing costs we will repay AND because the University and its hospital
are state assets, state backing would have a public cost benefit
3) Repayment of all bonded indebtedness from the new revenues we will
generate from the hospital and from donations
4) No additional state funding is required for the project as proposed
5) These actions would not establish a new hospital; rather, they would
enable JDH to move forward with OHCA’s standard Certificate of Need
process, which cannot be undertaken without a financing plan.
18
DEPARTMENT OF HEALTH CAREER OPPORTUNITY PROGRAMS (HCOP)
HEALTH PROFESSIONS PARTNERSHIP INITIATIVE (HPPI)
Great Explorations
(6th-8th grades)
Jumpstart
(9th-10th grades)
Health Professions Academy – Bulkeley &
Weaver High Schools
(9th-12th grades)
Pre-College Enrichment Program
(PCEP)
(College Pre-freshman)
Bridge to the Future Science
Mentorship Program
(6th-16th grades)
Mini Medical/Dental School
Program
(11th-12th grades)
College Enrichment Program
(CEP)
(College Sophomores)
University of Connecticut
Schools of Medicine, Dental Medicine and Graduate School
Health Career Discovery
Program
(11th-12th grades)
High School Summer Research
Apprentice Program
(12th grade)
Summer Research Fellowship
Program
(College Juniors)
Post-Baccalaureate Program
(Postbac Students)
Junior Doctors
Academy
(11th-12th grades)
Medical/Dental Preparatory
Program (MDPP)
(College Juniors/Seniors)
Bridges to the Baccalaureate Program
(Community College Students)
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UCHC: A Resource to the Community and the State
• Community Service:
•
•
•
•
•
•
•
•
•
South Park Inn Medical Clinic (Hartford)
South Marshall Street Homeless Clinic (Hartford)
Connecticut Poison Control Center
YMCA Adolescent Girls Medical Clinic (Hartford)
Camp Courant Dental Screening Program
Migrant Worker Clinic
Covenant House (Willimantic)
Huntington’s Disease Program
A.J. Pappanikou Center
20