The University in American Life:The Universityof North CarolinaHealth Care System

October 31, 2005

The UNC Academic Health Center Today

An integral part of the University of North Carolina at Chapel Hill

Does a University needa Teaching Hospital?

If yes, then why?

The Context of Health Carewithin the University

The health care system, like the University, 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.

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.

We will consider the evolution of UNC Hospitals and the UNC Health Sciences Center in that context.

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 programs “Hill Burton” funded hospitals developed 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 Formed - 1998

The University in American Life:1960’s & 1970’s

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

Improved access to outpatient services and new markets for hospitals

Continuing health manpower shortages Significant growth in NIH research funding

The UNCHCS Response:Focus on Mission

The Mission of the UNC Health Care System is to:– Provide high quality patient care– Educate health care professionals– Advance health and biomedical research– Serve the community

Unique Qualities of UNC Academic Health Center for North Carolinians

UNC 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, 2004-2005

The University Academic Health Center Environment: 1980’s

Increasing scrutiny of the cost of health services New payment 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

5,983 medical degrees awarded since the first class in 1954

Allied Health Sciences Enrollment in 2005 of 369 students (laboratory science, occupational therapy, physical therapy, radiologic science, speech and hearing, etc.)

Major growth in research faculty and facilities to support their efforts that continues today.

NIH Support to U.S. Institutionsof Higher Education Fiscal Year 2004

1 Johns Hopkins University 599,151,3092 University of Washington 473,432,1383 University of Pennsylvania 464,076,9254 UC-San Francisco 438,778,8315 Washington University 388,307,8756 University of Michigan 368,176,4467 UC-Los Angeles 361,593,4338 University of Pittsburgh 360,635,0359 Duke University 343,825,30410 Harvard University 325,665,20211 Yale University 323,614,09112 UC-San Diego 304,039,41013 Columbia University 303,714,70114 Stanford University 301,733,74415 UNC-Chapel Hill 289,652,93216 University of Wisconsin 264,059,40817 Vanderbilt 251,147,207

The Academic Health Center Environment: 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

Increasing consumerism - with attendant demands and expectations (patient’s rights)

Continued growth in challenging biomedical research Recognition of the special role of Academic Health Centers and

their societal contributions– Managed care entities wanted to use our “products”, but didn’t

want to pay for them

The UNC Health Care SystemToday

Profile

A system providing outpatient, inpatient, urgent, and emergent care

A comprehensive health center, providing services from wellness and preventive programs to organ transplants

Includes 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 place for clinical research A public facility, with societal obligations

The UNCHCS Vision

To be the nation’s leading public academic health care system

Leading. Teaching. Caring.

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

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

SurryAllegha

nyAshe

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

GatesCam

den

Pasquotank

DareTyrrellWashington

BeaufortHyde

Craven

Pamlico

Rockingham

Currituck

Perquimans

Chowan

Carteret

Orange

New Hanover

University of North Carolina HospitalsFY 2005 Inpatient Origin by N.C. County

UNC Hospitals

1-9 cases10-99 cases

100-249 cases

250-999 cases

1000+ cases

LEGEND

Total Discharges: 31, 334

University of North Carolina Hospitals - Distribution of Non-Reimbursed Care

(by County of Residence – North Carolina)FY 2005

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

Source: Actual 2005 charity and bad debts by residence of patients treated – UNCH’ Fiscal Services

Legend for Map

< $500,000

$500,000-$1M

$1M - $3M

> $3M

Currituck

Pasquotank

PerquimansChowan

Key Statistics - Fiscal Year 2005

31,322 Admissions 202,048 Inpatient Days of Care Average Length of Stay – 6.4 Days 680,689 Outpatient Physician Visits

– Includes 198,091 in off-campus sites 65,894 ER, Urgent Care and Peds ER Visits 253 Transplants (heart, lung, kidney, bone marrow,

liver, pancreas) 1117 Air Transports 3,574 Babies Delivered

UNC’s Clinical Support for Educational Programs

22% of active North Carolina Physicians Trainedat UNC Hospitals or UNC

Percent of Physicians Who Trained at UNC-CH(# of Counties)

All Physicians Trained at UNC (2)60.0% to 99.9% (3)30.0% to 59.9% (13)15.0% to 29.9% (44)5.3% to 14.9% (33)

No UNC-Trained Physicians (5)

Percent of Active Physicians Trained by UNC/UNC-CHNorth Carolina, 2004

Produced by: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.Sources: Alumni Affairs Data, 2004, and North Carolina Health Professions Data System, CecilG. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 2004. *Physicians included are active, instate, nonfederal, non-resident-in-training.

Total Active Non-Federal Physicians = 17,349

UNC / UNCH trained physicians* = 3,794

Total % of UNC Physicians in North Carolina = 22%

*Combines UNC graduates and UNCH residents in an unduplicated count.

UNC/UNCH trained 31% of the MDs in the 10 counties with the fewest MDs

Caswell Person

Gra

nvi

lle

Van

ce Warren

Franklin

Northampton

Halifax

WakeChatham

NashEdgecombe

Wilson

Johnston

Wayne

Lee

MooreHarnett

Sampson

Duplin

Pender

Brunswick

Columbus

BladenRobeson

Cumberland

HokeSco

tland

Guilford

Randolph

Montgom

ery

Richm

ond

Stokes

Forsyth

Davidson

Rowan

Stanly

AnsonUnion

Mecklen

bu

rg

Cabarrus

IredellDavie

Yadkin

Surry

AlleghanyAshe

Wilkes

Alexander

Catawba

Lincoln

GastonCleveland

Burke

Caldwell

Watauga

Avery

McDowell

Rutherford

Polk

Mitchell

Yancey

Buncombe

Henderson

Transy

lvan

ia

Hayw

ood

Madison

Swain

Jackson

Macon

Graham

ClayCherokee

Onslow

Jones

Lenoir

Greene

Pitt

Martin

Bertie

Hertford

Gates

Camden

Pasquotank

DareTyrrell

Washin

gton

Beaufort Hyde

CravenPamlico

Rockingham

Currituck

Ch

ow

an

Carteret

Ora

ng

eNew

Hanover

Du

rham

Ala

man

ce

Pasquotank

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 Board of Governors of University

of North Carolina System, upon recommendation of the President– 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 UNCHCS in Year 2005 and Beyond in Health Care’s Challenging Environment

Increasing demand for services versus declining payment 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 Significant emphasis on quality improvement and

patient safety And on the UNC campus …Parking, Parking, Parking

Positioned to Face the Challenges

New facilities developed and in planning Strong support for health science education Flexibility in response to human resource

issues Severe financial challenges ahead ? Parking, parking, parking……. Growing interface between patient care and

research

Carolina Roadmap to SuccessMultidisciplinary and Collaborative Research

The National Institutes of Health have devised a new, very competitive, Roadmap program.

Program is designed to transform the nation’s medical research capabilities and speed research discoveries from the bench to the bedside.

Carolina garnered 8 of these prestigious grants – more than any other institution in the nation.

Vanderbilt and Columbia - 6 Memorial Sloan-Kettering Cancer Center - 5 Johns Hopkins - 4 Harvard and Stanford - 3 Duke - 2

The Hospital and the University

Parallel Universes

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

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.