Transcript Document 7321452

UNC Hospitals
The University in
American Life: The
University of North
Carolina at Chapel Hill
October 13, 2003
The UNC Academic Health Center Today
An integral part of the University of North Carolina at Chapel Hill
Does a University need a Teaching
Hospital?
If yes, then why?
The Context of Health Care
within the University
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The health care system is a reflection of the society in
which is operates.
Health services have changed rapidly in the last 50
years, and the UNC Health Sciences Center reflects
that change.
Consider the evolution of UNC Hospitals and the UNC
Health Sciences Center in that context.
The service role of university-based teaching hospitals
is essential to the growth of educational and research
programs on the part of the health science faculty.
The University in American Life:
The 1940’s and 1950’s
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High rate of young North Carolina men not medically
eligible for the draft - rejected from military service in
WWII. Good Health Movement formed.
Increased awareness of the lack of health services in
North Carolina - especially in rural areas
A rapidly growing nation - health manpower shortages
Emerging expansion of health insurance
“Hill Burton” funded hospitals developing with a community service obligation
The University’s Response:
History and Evolution
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UNC School of Medicine
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North Carolina Memorial Hospital – 1952
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Named as a memorial to North Carolinians who died in all wars
Name changed to UNC Hospitals - 1990 – also kept the NCMH
NC Memorial Hospital separated organizationally from the
administration of UNC-Chapel Hill - 1971
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2 Year School - 1879
4 Year School – 1952
Board of Directors established
UNC Health Care System - 1998
The University in American Life:
1960’s & 1970’s
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Increased development of health insurance and
increased availability to the public
Medicare and Medicaid programs established as part
of the “Great Society” (1965)
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Increased access to health care by the “underserved” who
were generally the poor and minority populations
Increased access to outpatient services and new
markets for hospitals
Continuing health manpower shortages
Significant growth in NIH research funding
The University’s Response:
Focus on Mission
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UNC Hospitals is a public academic teaching
hospital operated by and for the people of
North Carolina. Our Mission is to:
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Provide high quality patient care
Educate health care professionals
Advance health and biomedical research
Provide community service
Unique Qualities of UNC Health Science
Center for North Carolinians
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UNC at Chapel Hill is the only University in the State of
North Carolina to have all 5 health sciences schools
and a major teaching hospital on one campus:
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Medicine & Allied Health
Public Health
Nursing
Pharmacy
Dentistry
Key links to other schools on Campus, and multiple
Centers, Institutes and Programs that provide both
research and service
Recognition of a state-wide role in health services
AHEC* Primary Care Training Sites
for Medical Students, Physician Assistants,
and Nurse Practitioners
Medical Student
Physician Assistant
Nurse Practitioner
* AHEC = Area Health Education Centers
North Carolina Area Health Education Centers
(AHEC) Program
Locations of Continuing Education Programs, 2001-2002
Mountain
Greensboro
Coastal
Northwest
Southern Regional
Area L
Charlotte
Wake
Eastern
AHEC Continuing Education Programs
Source: NC AHEC Program
The University in American Life:
1980’s
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Increasing scrutiny of the cost of health
services
New reimbursement schemes to control costs
Concerns about an “appropriate” number of
health professionals
Increasing regulatory environment in health
planning, service development, and quality
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Certificate of Need, Accreditation, Peer Review
Agencies
The University’s Response:
School of Medicine
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Between 1970 and 1980 the number of medical
students grew from 340 to its current size of 640
students and faculty grew accordingly.
5,391 medical degrees awarded over the years
Allied Health Sciences Enrollment in 2001 of 354
students (laboratory science, occupational therapy,
physical therapy, radiologic science, speech and
hearing, etc.)
Major growth in research faculty and facilities to
support their efforts
NIH Support to U.S. Institutions
of Higher Education
Fiscal Year 2002
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2
3
4
5
6
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10
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15
Johns Hopkins University
University of Pennsylvania
University of Washington
UC-San Francisco
Washington University
University of Michigan
UC-Los Angeles
University of Pittsburgh
Yale University
Duke University
Harvard University
Columbia University
UNC-Chapel Hill
Baylor College of Medicine
Stanford University
510,005,326
418,546,510
405,729,042
365,365,909
343,792,077
325,786,206
317,017,181
308,144,862
289,899,944
277,393,166
273,147,799
269,844,585
264,263,425
263,540,460
247,636,170
(Go HEELS!!!)
The University in American Life:
1990’s
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Rapidly changing health insurance market moving from indemnity
services to “managed care”
Increased emphasis on cost & questions about what quality health
care might be
Questions about limits to health services – rationing care
Increasing consumerism - with attendant demands and
expectations (patient’s rights)
Continued growth in challenging biomedical research
Recognition of the special roll of Academic Health Centers and
their societal contributions
– Managed care entities wanted to use our “products”, but didn’t
want to pay for them
What is UNC Hospitals Today?
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A facility providing outpatient, inpatient, urgent, and
emergent care
A comprehensive health center, providing services
from wellness and preventive programs to organ
transplants
A “system” including other owned or affiliated hospitals,
home health and hospice services
A community partner with other health care agencies
and services
A laboratory for teaching, and a locus for clinical
research
A public facility, with societal obligations
Special Features
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The first hospital in the country to provide intensive
care services
The only comprehensive burn center in North Carolina
(between D.C. and Atlanta)
A place where cutting edge research links to service
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Breakthrough treatments in hemophilia, respiratory diseases,
cystic fibrosis, gene therapy, AIDS, Cancer, and others
Serves North Carolinians of all walks of life
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>70,000 babies born since 1952 – Some with early challenges
University of North Carolina Hospitals
FY 2003 Inpatient Discharges by N.C. County
Total Discharges: 29,098
Alleghany
Northampton
Surry
Ashe
Watauga
Wilkes
Stokes
Avery
Forsyth
Alexander
Halifax
Franklin
Bertie
Chowan
Nash
Durham
Edgecombe
Martin
Washington Tyrrell
Wake
Chatham
Randolph
Wilson
Catawba
McDowell
Rowan
Pitt
Lincoln
Graham
Johnston
Lee
Beaufort
Greene
Rutherford
Jackson
Henderson
Polk
Macon
Cherokee
Alamance
Davidson
Iredell
Burke
Swain
Gates
Hertford
Davie
Madison
Buncombe
Granville
Warren
Vance
Orange
Guilford
Caldwell
Yancey
Person
Yadkin
Mitchell
Haywood
Caswell
Rockingham
Cabarrus
Cleveland
Gaston
Transylvania
Clay
Montgomery
Stanly
Harnett
Wayne
Moore
Lenoir
Craven
Mecklenburg
Pamlico
Cumberland
Union
Anson
Richmond
Hoke
Jones
Sampson
Duplin
Onslow
LEGEND
Scotland
Robeson
Bladen
Pender
1-9 cases
10-99 cases
100-249 cases
250-999 cases
1000+ cases
UNC Hospitals
Source: UNC Hospitals/HBO Trendstar Database
F:\planning\rr\unch ip origin fy 03_2.ppt
Columbus
New Hanover
Brunswick
Carteret
Hyde
Dare
University of North Carolina Hospitals - Distribution of
Non-Reimbursed care
(by County of Residence – North Carolina)
FY 2003
Camden
Alleghany
Northampton
Ashe
Watauga
Surry
Wilkes
Stokes
Avery
Iredell
Swain
Orange
Guilford
Rutherford
Jackson
Henderson
Polk
Bertie
Franklin
Randolph
Chatham
Cabarrus
Wilson
Johnston
Harnett
Stanly
Martin
WashingtonTyrrell
Dare
Wake
Lee
Gaston
Perquimans
Chowan
Nash
Pitt
Rowan
Cleveland
Currituck
Pasquotank
Halifax
Edgecombe
Davidson
Lincoln
Graham
Cherokee
Catawba
McDowell
Hertford
Davie
Burke
Buncombe
Vance
Durham
Caldwell
Madison
Haywood
Warren
Person
Yadkin
Forsyth
Yancey
Rockingham Caswell
Gates
Wayne
Moore
Beaufort
Hyde
Greene
Craven
Lenoir
Macon
Clay
Union
Anson
Hoke
Cumberland
Pamlico
Sampson
Duplin
Jones
Onslow
Carteret
Robeson
Bladen
Pender
Legend for Map
< $500,000
Columbus
New Hanover
$500,000-$1M
Brunswick
$1M - $3M
> $3M
Source: Actual 2003 charity and bad debts by residence of patient schedule - UNCH finance
UNC’s Clinical Support for Educational Programs
23% of active North Carolina Physicians Trained
at UNC Hospitals or UNC
Active Physicians Trained by UNC/UNCH
Percentage by County
Alleghany
Ashe
Surry
Stokes
Yadkin
Haywood
Buncombe
Burke
McDowell
Jackson
Cherokee
Granville
Warren
Vance
Northampton
Halifax
Gates
Forsyth
Orange
Guilford
Hertford
Perquimans
Chowan
Bertie
Franklin
Lincoln
Nash
Durham
Edgecombe
Davie
Davidson
Martin
Wake
Randolph
Chatham
Wilson
Pitt
Rowan
Washington
Gaston
Transylvania
Clay
Harnett
Montgomery Moore
Craven
Richmond
Cumberland
Pamlico
Sampson
Duplin
Hoke
Scotland
UNC / UNCH trained physicians* =
Total % of UNC Physicians in North Carolina =
Carteret
Bladen
Pender
13,782
3,164
Jones
Onslow
Robeson
Total Active Non- Federal Physicians =
Hyde
Lenoir
Mecklenburg
Anson
Dare
Wayne
Stanly
Union
Tyrrell
Beaufort
Greene
Lee
Cabarrus
Cleveland
Henderson
Camden Currituck
Pasquotank
Johnston
Polk
Macon
Alexander
Iredell
Catawba
Rutherford
Graham
Person
Alamance
Caldwell
Madison
Swain
Caswell
Wilkes
Watauga
Mitchell Avery
Yancey
Rockingham
Legend for Map
0%
Columbus
23%
New Hanover
Brunswick
1-15%
16-30%
31-45%
46-60%
61-75%
* Combines UNC graduates and UNCH residents in an unduplicated count
76-100%
Source: Alumni Affairs Data, 2/14/96 and NC Health Professions Data System: 1996 Physicians, Sheps Center.
UNC/UNCH trained 50% of the MDs in the 10 counties with the fewest MDs
UNC Health Care System - Formed 1998
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What is it?
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An integrated health care system, owned by the State of North
Carolina and based in Chapel Hill.
Who is it?
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UNC Hospitals and the practice plan of the School of Medicine
were combined into a single system, with a single CEO
The UNCHCS was given management flexibility in purchasing,
consultation, construction, and human resources activities to
assure its management flexibility and competitiveness in a
rapidly changing health care business environment.
UNC Health Care System
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Why create it?
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How is it governed?
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More responsive to the “marketplace”, blending the cultures of
the academic base with the marketplace
Allowed for needed flexibility from State management systems
A Board of Directors is appointed by President of University of
North Carolina System
Board includes state-wide community representatives and
representatives from UNC- Chapel Hill, UNC Hospitals, and
the School of Medicine
What is it?
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UNC Hospitals, Rex Healthcare, Home Health and Hospice,
etc.
The University in American Life:
Year 2000 and Beyond
Health Care’s Challenging Environment
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Increasing demand for services versus declining
reimbursement and increasing costs
Staffing shortages – especially registered nurses
Challenges in resource allocation and in priority setting
for program development
Capital program growth and development
Heavy and costly regulation
And on the UNC campus …Parking, Parking, Parking
NC Children’s and Women’s Hospitals
The Hospital and the University
Parallel Universes
Policy & Program Opportunities
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Development planning and coordination
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Infrastructure development and support
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UNCHCS Facility Master Plan in University
Development Plan
Adjacent facilities and future growth potential
Parking subsidies and utility development
Community relations
Program development and growth
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University Child Care Center
Ronald McDonald House & Family House
UNC Hospitals and UNCHCS
Facility Master Plan
Heart
Center
Cancer
Center
Musculoskeletal
Center and
Ambulatory Care
Day-to-Day Operations:
Mission Focused
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Educate new health professionals and offer
young people opportunities for growth
Serve people statewide through the patient
care provided and constantly developed while
also educating and learning new things
Provide a laboratory for clinical research done
by the health science schools with care for
protection of patients and understanding of
those who participate.
ROLE of one PHYSICIAN in
Academic
Health Care Center
When you’ve seen
one MD at an AMC,
you’ve seen one MD
at an AMC
Context
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UNC BS in Zoology 1977
Didn’t get into MD first time applied
UNC MD 1982
UNC Ob Gyn Residency 1986
UNC Maternal Fetal Medicine Fellowship 1988
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Assistant Professor 1988
Associate Professor 1994
Professor 2001
Four Legged Stool of Academic Medical
Center MD
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Clinical
Research
Teaching
Administration
CLINICAL
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Private High Risk Obstetrics Practice
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Consultative Ultrasound Practice
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1 ½ day per week
In House Night Call
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2 ½ days per week
High Risk Obstetrics Practice
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2 ½ days per week
3 nights per month
Phone Night Call
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3 nights per month
Research
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40% TIME AT THE NIH IN WASHINGTON
COLLABORATOR ON MANY PROJECTS
LOCALLY
EASIEST TO QUANTIFY IN PROMOTION
AND TENURE DECISIONS
TEACHING
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TEACHING PORTFOLIO
AT RISK WITH CURRENT CLIMATE
VARIOUS DEFINITIONS
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CLASS ROOM TEACHING
WARD TEACHING
CLINIC TEACHING
MENTORING
LABORATORY STUDIES
RESEARCH MENTORS
ADVISING
ADMINISTRATION
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No longer included in Promotion and Tenure
decisions
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Committee work
Medical director ambulatory clinics
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Ob Gyn: > 50% of revenues
Program director fetal therapy program
An AMC on a University Campus?
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Major advantage to recruiting
new dean/CEO/ Vice
Chancellor for Health Affairs
for the University
Joint departments that
interrelate
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Genetics
Biology
Pharmacy
Nursing
Public Health
Orange Cardiovascular
Foundation
Important issues facing AMC’s
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Changing demographics
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Cultural competency
Geriatrics
No money, no mission
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“Provide health care for the people of NC”
The School of Medicine of UNC at
Chapel Hill is dedicated to:
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Improving the health and life quality of North
Carolinians by:
1. Educating medical students, residents,
practicing physicians, and pre- and postdoctoral basic and allied health science
students.
2. Providing care to all patient presenting o
UNC Health Care System regardless of their
ability to pay.
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3. Conducting scholarly investigation in biomedical,
behavioral, and social sciences
4. Stimulating economic development in the state
through bio-technical innovation
5. Providing leadership in all of these areas
Priority project focus on prevention, detection and
treatment of prevalent illnesses and disabilities of the
states’ citizens.,….
Key Statistics - Fiscal Year 2003
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653,473 Outpatient Physician Visits
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Includes 162,711 in off-campus sites
42,243 ER Visits
977,414 Total Outpatient Visits Hospital-Wide
29,129 Admissions
190,596 Inpatient Days of Care
Average Length of Stay – 6.6 Days
4,826 Newborn Days of Care
216 Transplants (heart, lung, kidney, bone marrow, liver, pancreas)
925 Air Transports
3,100 Deliveries
25,902 Home Health Visits
3,896,610 Laboratory Tests Provided
UNC-CH School of Medicine
Distinguishing Feature:
Bimodal Medical Schools
Ranked in top 20% by AAMC in production
of primary care physicians and in receiving
research grants from NIH.
• UNC-Chapel Hill
• UC-San Diego
• UC-San Francisco
• U. of Washington
UNC Hospitals
Positioned to Face the Challenges
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New facilities developed and in planning
Strong support for health science education
Flexibility in response to human resource
issues
? Parking, parking, parking…….