unc hospitals the university in american life: the university of north carolina at chapel hill...
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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
The Context of Health Carewithin the University
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
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
UNC School of Medicine 2 Year School - 1879 4 Year School – 1952
North Carolina Memorial Hospital – 1952 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
Board of Directors established UNC Health Care System - 1998
The University in American Life:1960’s & 1970’s
Increased development of health insurance and increased availability to the public
Medicare and Medicaid programs established as part of the “Great Society” (1965)
– 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
UNC Hospitals is a public academic teaching hospital operated by and for the people of North Carolina. Our Mission is to:– 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
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:
– 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
Medical Student
Physician Assistant
Nurse Practitioner
AHEC* Primary Care Training Sites for Medical Students, Physician Assistants, and Nurse Practitioners
* AHEC = Area Health Education Centers
North Carolina Area Health Education Centers (AHEC) Program
AHEC Continuing Education ProgramsSource: NC AHEC Program
MountainGreensboroCoastalNorthwestSouthern Regional
Area LCharlotteWakeEastern
Locations of Continuing Education Programs, 2001-2002
The University in American Life:1980’s
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– Certificate of Need, Accreditation, Peer Review
Agencies
The University’s Response:School of Medicine
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
1 Johns Hopkins University 510,005,3262 University of Pennsylvania 418,546,5103 University of Washington 405,729,0424 UC-San Francisco 365,365,9095 Washington University 343,792,0776 University of Michigan 325,786,2067 UC-Los Angeles 317,017,1818 University of Pittsburgh 308,144,8629 Yale University 289,899,94410 Duke University 277,393,16611 Harvard University 273,147,79912 Columbia University 269,844,58513 UNC-Chapel Hill 264,263,42514 Baylor College of Medicine 263,540,46015 Stanford University 247,636,170
NIH Support to U.S. Institutionsof Higher Education Fiscal Year 2002
(Go HEELS!!!)
The University in American Life:1990’s
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?
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
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– Breakthrough treatments in hemophilia, respiratory diseases,
cystic fibrosis, gene therapy, AIDS, Cancer, and others
Serves North Carolinians of all walks of life– >70,000 babies born since 1952 – Some with early challenges
University of North Carolina HospitalsFY 2003 Inpatient Discharges by N.C. County
Total Discharges: 29,098
Yancey
Caswell PersonGranville
VanceWarren
Franklin
Northampton
Halifax
Alamance Durham
WakeChatham
NashEdgecombe
Wilson
Johnston
Wayne
Lee
MooreHarnett
SampsonDuplin
Pender
Brunswick
Columbus
BladenRobeson
CumberlandHoke
Scotland
Guilford
Randolph
Montgomery
Richmond
Stokes
Forsyth
Davidson
Rowan
Stanly
AnsonUnion
Mecklenburg
Cabarrus
Iredell
Davie
Yadkin
SurryAlleghany
Ashe
Wilkes
Alexander
Catawba
Lincoln
GastonCleveland
Burke
Caldwell
Watauga
Avery
McDowell
Rutherford
Polk
Mitchell
Buncombe
Henderson
Transylvania
Haywood
Madison
Swain
Jackson
Macon
Graham
ClayCherokee
Onslow
Jones
Lenoir
Greene
Pitt
Martin
Bertie
Hertford
Gates Camden
Pasquotank
DareTyrrellWashington
BeaufortHyde
Craven
Pamlico
Rockingham
Currituck
Perquimans
Chowan
Carteret
Orange
New Hanover
UNC Hospitals
1-9 cases
10-99 cases
100-249 cases
250-999 cases
1000+ cases
LEGEND
Source: UNC Hospitals/HBO Trendstar Database
F:\planning\rr\unch ip origin fy 03_2.ppt
Caswell
Person
Gra
nville
Vance
Warren
Franklin
Northampton
Halifax A
lam
an
ce
Durham
Wake Chatham
Nash
Edgecombe
Wilson
Johnston
Wayne
Lee
Moore
Harnett
Sampson Duplin
Pender
Brunswick
Columbus
Bladen
Robeson
Cumberland Hoke
Scotland
Guilford
Randolph
Montgom
ery
Ric
hm
on
d
Stokes
Forsyth
Davidson
Rowan
Stanly
Anson
Union
Meckle
nb
urg
Cabarrus
Iredell
Davie
Yadkin
Surry
Alleghany
Ashe
Wilkes
Alexander
Catawba Lincoln
Gaston
Cleveland
Burke
Caldwell
Watauga
Avery
McDowell
Rutherford Polk
Mitch
ell
Yancey
Buncombe
Henderson
Transylvania
Haywood
Madison
Swain
Jackson
Macon
Graham
Clay
Cherokee
Onslow
Jones
Lenoir
Greene
Pitt
Martin
Bertie
Hertford
Gates
Dare
Camden
Tyrrell
Washington
Beaufort Hyde
Craven
Pamlico
Rockingham
Carteret
Orange
New Hanover
University of North Carolina Hospitals - Distribution of Non-Reimbursed care
(by County of Residence – North Carolina)FY 2003
Source: Actual 2003 charity and bad debts by residence of patient schedule - UNCH finance
Legend for Map
< $500,000
$500,000-$1M
$1M - $3M
> $3M
Currituck
Pasquotank
PerquimansChowan
Caswell PersonGranville
VanceWarren
Franklin
Northampton
Halifax
AlamanceDurham
Wake
Chatham
Nash
Edgecombe
Wilson
Johnston
WayneLee
Moore Harnett
Sampson
Duplin
Pender
Brunswick
Columbus
BladenRobeson
CumberlandHoke
Scotland
Guilford
Randolph
Montgomery
Richmond
Stokes
Forsyth
Davidson
Rowan
Stanly
AnsonUnion
Mecklenburg
Cabarrus
Iredell
Davie
Yadkin
Surry
AlleghanyAshe
Wilkes
Alexander
Catawba
Lincoln
GastonCleveland
Burke
Caldwell
Watauga
Avery
McDowell
Rutherford
Polk
MitchellYancey
Buncombe
Henderson
Transylvania
Haywood
Madison
Swain
Jackson
Macon
Graham
ClayCherokee
Onslow
Jones
Lenoir
Greene
Pitt
Martin
Bertie
Hertford
Gates Camden
Pasquotank
DareTyrrell
Washington
Beaufort
Hyde
Craven
Pamlico
RockinghamCurrituck
Perquimans
Chowan
Carteret
Orange
New Hanover
UNC’s Clinical Support for Educational Programs 23% of active North Carolina Physicians Trained
at UNC Hospitals or UNC
Total Active Non- Federal Physicians = 13,782
UNC / UNCH trained physicians* = 3,164
Total % of UNC Physicians in North Carolina = 23%
* Combines UNC graduates and UNCH residents in an unduplicated countSource: 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
Active Physicians Trained by UNC/UNCH
Percentage by County
0%
1-15%
16-30%
31-45%
46-60%
61-75%
76-100%
Legend for Map
What is it?– An integrated health care system, owned by the State of North
Carolina and based in Chapel Hill.
Who is it?– 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 - Formed 1998
UNC Health Care System
Why create it?– More responsive to the “marketplace”, blending the cultures of the
academic base with the marketplace– Allowed for needed flexibility from State management systems
How is it governed?– 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?– UNC Hospitals, Rex Healthcare, Home Health and Hospice, etc.
The University in American Life:Year 2000 and BeyondHealth Care’s Challenging Environment
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
Policy & Program Opportunities
Development planning and coordination– UNCHCS Facility Master Plan in University Development Plan– Adjacent facilities and future growth potential
Infrastructure development and support– Parking subsidies and utility development
Community relations Program development and growth
– University Child Care Center– Ronald McDonald House & Family House
UNC Hospitals and UNCHCSFacility Master Plan
CancerCenter
HeartCenter
MusculoskeletalCenter and
Ambulatory Care
Day-to-Day Operations:Mission Focused
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
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
CLINICAL
Private High Risk Obstetrics Practice– 2 ½ days per week
Consultative Ultrasound Practice– 2 ½ days per week
High Risk Obstetrics Practice– 1 ½ day per week
In House Night Call– 3 nights per month
Phone Night Call– 3 nights per month
Research
40% TIME AT THE NIH IN WASHINGTON COLLABORATOR ON MANY PROJECTS
LOCALLY EASIEST TO QUANTIFY IN PROMOTION
AND TENURE DECISIONS
TEACHING
TEACHING PORTFOLIO AT RISK WITH CURRENT CLIMATE VARIOUS DEFINITIONS
– CLASS ROOM TEACHING– WARD TEACHING– CLINIC TEACHING– MENTORING– LABORATORY STUDIES– RESEARCH MENTORS– ADVISING
ADMINISTRATION
No longer included in Promotion and Tenure decisions– Committee work– Medical director ambulatory clinics
Ob Gyn: > 50% of revenues
– Program director fetal therapy program
An AMC on a University Campus?
Major advantage to recruiting new dean/CEO/ Vice Chancellor for Health Affairs for the University
Joint departments that interrelate
– Genetics– Biology– Pharmacy– Nursing– Public Health
Orange Cardiovascular Foundation
Important issues facing AMC’s
Changing demographics– Cultural competency– Geriatrics
No money, no mission– “Provide health care for the people of NC”
The School of Medicine of UNC at Chapel Hill is dedicated to:
Improving the health and life quality of North Carolinians by:
1. Educating medical students, residents, practicing physicians, and pre- and post-doctoral basic and allied health science students.
2. Providing care to all patient presenting o UNC Health Care System regardless of their ability to pay.
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
653,473 Outpatient Physician Visits– 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 MedicineDistinguishing 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