University of Utah – Medical Education & Discovery (MED)/Rehabilitation Hospital
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As presented at the September 17, 2015 Board of Regents meeting at Utah State University in Logan, Utah.
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University of Utah – Medical Education & Discovery (MED)/Rehabilitation Hospital
- 1. IN THE FACILITIES OF THE PAST Vivian S. Lee, M.D., Ph.D., M.B.A. Senior Vice President, University of Utah Health Sciences CEO, University of Utah Health Care Dean, University of Utah School of Medicine TRAINING THE PROVIDERS OF THE FUTURE
- 2. A Vision from 1965 50 years ago, UUSOM was given a home with the goal that the University Hospital “would facilitate carrying on the highest grade of scientific work, which by the quality and reputation of its clinical work would attract patients from the whole Mountain Region irrespective of their economic status.” “…The building’s seismic issues are significant enough that the building is unsuitable for continued use as a clinical care and research facility. The deficiencies cited are considered a hazard to occupants and a liability to the university.” – 2013 Study
- 3. • School of Medicine is the only Medical School in the State and Region • Over 80% of Students are Utah residents or UT high school or college graduates • We train 2/3rds of the physicians in the state • Departments provide telehealth services to remote clinics across the state and region
- 4. Training Providers to be the Best in the Nation
- 5. Training the Providers of the Future in the Facilities of the Past
- 6. A Vision for the Future INTERPROFESSIONAL MEDICAL INNOVATION POPULATION HEALTHBIG DATA
- 7. Building 521: School of Medicine University of Utah Hospital Huntsman Cancer Institute Primary Children’s Medical Center School of Medicine
- 8. Medical Education & Discovery Medical Education and Discovery Center Rehabilitation Hospital Ambulatory Care Center
- 9. Ambulatory Care Center School of Medicine Ambulatory Care Center
- 10. Rehabilitation Hospital Rehabilitation Hospital Ambulatory Care Center School of Medicine
- 11. Medical Education & Discovery Medical Education and Discovery Center Rehabilitation Hospital Ambulatory Care Center
- 12. The MED Complex: Doing More With Less Existing Space to be Demolished (GSF) 639,174 New Space to be Constructed (GSF) 500,000
- 14. Estimated Costs
- 15. Questions?
Notas del editor
- Thank you for the opportunity to talk today It’s safe to say that today, EVERYTHING in health care is changing HC costs account for nearly 20% of the GDP More patients are aging and gaining insurance, putting further strains on the system And innovations in research and discovery (the very things we need to improve care and decrease costs) are challenged by decreases in funding The way forward is to integrate and leverage our strengths in clinical/academic/education To do more with less… something that is in our DNA as a university health system I’ll show you briefly what I mean…
- 50 years ago… Today, 521 is a seismic risk, its functional systems have outlived their lifespan, and the types of clinic, patient and student training facilities are not suitable for future or even current care delivery and collaboration. We have done a great deal to make this building functional – delivering outstanding care and top notch education. We are doing the best we can with what we have. We have XXX,000 SF of patient care spaces including a Rehabilitation Unit, Psychiatric Unit and numerous Outpatient Clinics serving patients from 10% of the continental U.S. We have researchers and faculty and students and administration—all working in a building that is falling apart. We performed numerous comprehensive studies of the existing facilities, the most recent completed in December of 2013, concluded that the School of Medicine building should be demolished and replaced rather than renovated. The 2013 study concluded that [CLICK] “The building’s seismic issues…” The study found that the construction cost of the substantial renovation required for these buildings, using the assumptions in the study, was estimated at $222 million. Additionally, the existing buildings have fundamental design flaws which will remain after a renovation. Other Post-Renovation Deficiencies include: Low floor-ceiling heights Small structural bays Large column sizes Inefficient net-to-gross sf ratios 8) The study concluded that the money saved by renovating is not worth the end result of a flawed building that would not meet the functional requirements of a state-of-the-art facility providing education and health care services to Utah residents for decades to come. Additionally, the mechanical and electrical systems of both buildings are at the end of their useful life with the possibility of component and catastrophic failure at any time. This poses a serious threat to the building’s functioning that must be addressed. A catastrophic failure of these components would require moving over a thousand people out of the building – inpatients, outpatients, faculty, staff and students over an extended period of time. 9) This is the heart of the medical school and it is both unpredictable and costly—with an estimated annual cost of XXX to keep this inefficient building operational. NOW 40k rehab 10k psych 50k ambulatory 100k net (270k net) 40% clinical
- School of Medicine is the only Medical School in the State and Region Over 80% of Students are Utah residents or UT high school or college graduates We train 2/3rds of the physicians in the state… [THANKS TO YOU] Departments provide telehealth services to remote clinics across the state and region
- We have taken all we learn and all we do to develop a vision for the future… This is our high-value equation. A new model of patient centered care that our customers are demanding: high quality care and exceptional service delivered at a reasonable cost. And we are well on our way. Today, we serve 10% of the continental U.S. with some of the highest quality care in the nation, we attract and train providers who are ranked in the top 10% in patient satisfaction in the nation, and we provide some of the lowest cost health care per-capita, in the country. In this system, we are training providers to be some of the best in the nation.
- Additionally, we are training our providers with in antiquated spaces with antiquated technologies There are some fundamental design issues – massive size, energy inefficiency, confusing layout, structural elements that limit our ability to reconfigure spaces efficiently Will see different types of space, but underscore that these are ALL teaching and learning spaces for our students. HSEB is mostly classroom – bulk of education is in clinical setting Perhaps more importantly, we are training our providers in silos for work that will require they work in teams Working at the tops of their licenses for great efficiency in care They are currently spread across campus, expected to succeed in (mostly clinical) training that will require interprofessional efficiencies [CLICK] Our students are our secret sauce, and thanks to the legislature we now train 122 every year But doctors alone aren’t the only answer Health care of the future is delivered in teams, nurses, PA’s, MA’s, pharmacists Tomorrow we must be prepared to deliver care across the lifespan of our patient’s health – from wellness to specialty, from oral health to pharmacologic, and more
- We are evolving a NEW MODEL OF HEALTH CARE defined by quality, affordability and service. This model of care will be delivered with new approaches to population and public health, new telehealth accessibilities, and new medical devices and “apps” that will prevent, diagnose, and treat. It will be informed by lessons in health systems innovation research and big data informatics that draw on a diversity of sources to map the best way forward. AS CARE DELIVERY CHANGES, HOW WE TEACH, TRAIN AND INNOVATE WILL CHANGE—demanding interprofessional, multi-disciplinary and cross- collaborative curricula. Above all, we need to train our students to balance the new with a strong foundation of compassion and humanity.
- [Talk through existing footprint and the challenges of taking down a functioning 650,000 sf facility]
- Inpatient will move to new Rehabilitation Hospital and current hospital
- Outpatient clinics to new Ambulatory Care Center and decanted visits to other sites Essential services to new Ambulatory Care Center Opportunity to move closer to community
- We are decreasing the overall size and efficiency of the SOM Moving labs offsite and creating more integrated collaborations across campus Moving clinics offsite and closer to our patients Increase in State Funded O&M: $470,600 9.9% of total O&M for MED/Rehab
- We’ve been planning since I arrived—huge project lots of coordination, deca Why now talking points: $7-$7.5m escalation in building costs by delaying 1 year. $1-1.25m for each basis point on interest rates—could add $3-5m on costs Seismic/system failure risk—major utility system (patient care in that building) Decanting the building and renting space to temporarily house—those costs will accumulate the longer we delay Donor expectations 2020 a long time Easily $12m cost just by delaying 1 year.
- ACC already been approved; bringing CBR for remaining major projects Capital budget request is 270M, total investment is 370M with request to state for 50M Good progress and on-track for funding discussions – we are confident that we will secure this level of philanthropic support final stage of gift agreement language with foundation for rehab we have been approached by benefactors for discovery and global health no concerns about the MED funding based on ongoing conversations with several potential donors Clinical pro formas can handle debt service at under very conservative assumptions State ask is less than 15% total investment Per CBR, pushing the dates out one year adds $13.6M to the construction and related costs. There is also interest rate risk for bonding. Assuming that we will bond $45M for Rehab and $50M for MED (assuming we need the bonding because gifts will come in over a 5-10 year period), each 0.1% increase in interest rates adds $1.2M to the project cost. Depending when and how fast the Fed moves, this could conceivably add $3-5M of total cost. This is the timeline donors are excited about and working with for their contributions.
- We would appreciate your support and would like to take your questions