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.