2008 | USF Health Transforming the Future

Stephen Klasko, MD, MBAVP, USF Health

Dean, USF College of Medicine

January 17, 2008Board of Trustees / Health Sciences and

Research Workgroup

The USF Health story We need new ways of understanding health –

leading to new ways of designing health care

As a result, in 2005 we created USF HEALTH across medicine, nursing, public health, physical therapy … and more

These touchstones have guided decision-making aimed at national prominence: We will not invest in less.

2005 | Looking Ahead Blueprint for Strategic Action:

Creative Educational Models

Creative Educational Creative Educational ModelsModels

Research Really Matters

Research Really Research Really MattersMatters

Creative/Successful Practice Models

Entrepreneurial Academic Practice ModelsPractice Models

True Collaboration: COM + HSC +

University

True Collaboration: True Collaboration: USF Health +

UniversityUniversity

Strive for National Prominence

Strive for National Strive for National ProminenceProminence

2007 Creative Educational Models

All colleges: USF is first choice for students who want to be LEADERS

All colleges: Students launch first student run clinic – “The BRIDGE”

Students adopt Carl Sagan - an East Tampa charter school

USF COM one of nation’s most

innovative curricula including scholarly concentrations

2007 Creative Educational Models

CON - Launched new programs Nurse Anesthesia (CRNA) Doctorate of Nursing Practice

Baccalaureate Specialties Accelerated (2nd Bachelor’s) First Time in College (FTIC)

Joint JD/MPH and JD/MD are fully operational with Stetson Law School.

COPH - Recent recognition by the Peace Corps for Masters International Program.

2007 - Transformation of Research(i.e. Research Really Matters)

Vision:Articulated a Strategic and a Business Plan to accomplish top 50 status in NIH funding in five years

Established three Interdisciplinary Signature Programs

Colleges: COPH concluded successful recruitment of Global Infectious Disease Research teamincluding:

World Class Scholars Tom Unnasch, John Adams, and Wil Milhous who join Dennis Kyle in forming this outstanding team.

COM established a School of Biomedical Sciences to streamline services and converge resources

Jeff Krischer awarded $169M to coordinate a 10-year study in juvenile diabetes CON jumped from 53 to 42 in nation, with goal of top 20 in research funding.

Directors appointed for Nursing Research Center & Pyschoneuroimmunology Nursing Center; Maureen Groer received a $1.45M NIH grant to explore how changes in the immune function following childbirth may affect the physical and mental health of mothers.

USF Health Awards Year to Date Comparisons

53

98

36

72

17

26

0

20

40

60

80

100

120

FY 06-07 FY07-08

Fiscal Years

Funding ($; in millions)

Total Federal Non-Federal

2007 | USF Faculty Practice Group

For the year ending FY 06-07, the faculty practice group had an over-recovery from operations of approximately $900,000.  

FY 07-08 will finalize our ability to be the first academic practice group that will be totally electronic

– Two year: $15 million investment– USF will serve as the Southeast representative for the

NEPSI (National Electronic Prescribing Safety Initiative)– Total integration of our forty different practice sites

The below the line number (non-cash) is over a $7

million gain, including:– investment income from our reserves and the bond

proceeds – the development match for our electronic health care

purchase.

ChargesFiscal Years 1999 - 2007

$339,251,521

$150,677,947

$166,514,958$171,691,843

$187,630,592 $202,866,610$218,400,320

$255,863,449

$297,260,564

$352,424,012

$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

$300,000,000

$350,000,000

$400,000,000

FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2008(Annualized)

CollectionsFiscal Years 1999 - 2007

$115,838,398

$106,504,175

$97,658,177

$88,278,743$83,642,942

$74,454,939$69,331,008$65,172,020

$63,919,105

$123,164,416

$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2008(Annualized)

Global RVUsFiscal Years 2000, 2001, 2002, 2003, 2004, 2005, 2006, and 2007

1,984,581

2,077,5802,307,714

2,527,5772,694,177 2,739,222

2,919,4743,355,148

3,552,624

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2008

(Annualized)

Development of a True Multispecialty Group:– There is no practice group in the nation that can prosper without

anesthesiology, radiology, pathology, facility fees and hospital revenues

Financial Challenges:– Medicare funding reductions– Increased competition– Reduced state resources– Moffitt practice group (both a challenge and an opportunity)

Operational Challenges:– Moving from a practice “plan” to a vibrant multispecialty group

2008 | USF Faculty Group Challenges

Changes in practice group administration More entrepreneurial Doctor/Staff Friendly Reduction of overheads

Coordinated patient care through referral within our practice group

Take advantage of our new facilities in hospital based areas such as pathology and radiology

2008 | Changing the Paradigm of Our Internal Practices

Looking Into the Future Today’s Perspective - Our Financial Challenges

Reduced State Support <$6M>

Debt Service new buildings <3M>

Medicare Reductions <4M>

Practice Plan margin for reinvestment <3M>

Moffitt Overhead <3M>

<$19M>

Planning Options (Increases)

Improve current clinical patient service revenue $10M

Reduce central practice group expenses 3.5M

Reduce clin. dept. duplication practice group svcs 1.5M

Moffitt transition funding 2.2M

Reduce travel, events, functions, food 1.3M

Consolidate practice plan & COM adm (IT) .5M

Harborside lease savings 1.0M

Reduce USF Health VP initiatives 1.0M

Morsani Center Imaging & Amb. Surg Strategies 2.0M

$23M

Challenges (Reductions)

2007 | Hospitals

We launched the ambitious goal to transformthe standard of health care in the region

US News – Gyn at TGH is 25th in nation – Top 50 ENT, Liver Transplant, Urology

Orthopedic residency for first time in 15 years Recruitments 2007

– Dr. Lewis Rubin from Cleveland Clinic - Muma chair for Neonatology

– Dr. Clifton Gooch from Columbia University - Chair of Neurology

Renegotiating relationships with Moffitt, ACH, TGH, VAs

Exploring new relationship with BayCare

No model exists in the U.S. where a medicalschool affiliated with three or four strategicallyindependent (both of the medical school and eachother) has been able to achieve what we intend towithout dramatically changing.

– University hospital– Fundamental change in the philosophy

and by laws of affiliate hospital

Our Reality

No orthopedic residency in Tampa for fifteen years Private group at TGH held the fate of orthopedic

trainees hostage for that length of time In 2007, USF Orthopedics begun with residency

approved, UCH as the primary hospital, and a “deal” with our primary teaching hospital that we would not practice there

Our adopted hospital, UCH, has decided to limit the amount of USF physicians with privileges

In 2008, despite incredible success in recruiting physicians, building a great residency (500 applicants for four positions) we are looking for a hospital partner

Case Study: Orthopedics

Two of the most performed (and the only orthopedic procedures measured by Healthgrades) are total hip replacement and total knee replacement

TGH (FOI), St Joseph’s and Brandon are all poor in outcomes for hip replacement (Healthgrades 2008)

TGH (FOI), Brandon and Florida Hospital Zephyr Hills are all poor in outcomes for knee replacement (Healthgrades 2008)

Would a Unversity hospital that raised the bar for care in the community by bringing in new faculty members with a commitment to excellence help raise the bar for all hospitals?

Ask Pittsburgh, Birmingham, Columbus, Farmington, Sacramento

Orthopedics in Tampa Bay

Healthcare: Academic Entrepreneurial Practice Models

Centers forAdvanced Healthcare: Model for transforming ambulatory care, CRISPS

USF Health South Tampa Center for Advanced Healthcare opened August 27, 2007

Morsani Center on campus of USF Health opens Summer 2008

Priority to Transforming Healthcare in Tampa Bay Region: University Hospital

Note: 1970 USF Medical Center Master Plan Phase III In-patient Hospital Facilities

Bottom Line

USF COM was born as a community model, non research intensive medical school

Its adolescence has been marked by a desire to break out of that mold

There is an increasing gap between research “haves” and “have nots” in medical schools

Legislative Statute Allows Florida’s medical colleges given the appropriate funding to build an

academic medical center on their campus

There are no world renowned medical schools without that opportunity in this country

The statute does not address CON reform in any other manner, so arguments about single specialty doctor owned hospitals do not apply

Having said that, many states have passed prudent CON reform which makes it easier for hospitals to expand appropriately without “opening the floodgates.”

CON exemption would be a policy statement by the state to support the capacity and future of USF Health to have control over its clinical, research and educational health services — it is not an economic commitment by the state.

  That hospital would not compete with our partnership at TGH, because the TGH

arrangement does not include clinical services such as anesthesiology, pathology, radiology and orthopedic surgery; and the exemption would not compete with the BayCare community hospital partnership in Pasco, which is primary and secondary care.

Measuring Quality | Where is Tampa?

No hospitals in Solucient Top 100 (2006)

No hospitals in US News Honor Roll (2007)

No hospitals among Healthgrades Florida’s best hospitals (2008)

No hospitals among Healthgrades Florida’s excellence for patient safety (2008)

No hospitals among Healthgrades Florida’s clinical excellence (2008)

No hospitals with better than expected Coronary Bypass outcomes (2008)

Despite USF being shut out of the orthopedic market for fifteen years-TGH, St Joes and Brandon are all “poor” in hip replacement

Recruitment of Faculty, Staff & Students

Research Funding Publications Consumer Awareness Physician Referrals Patient Referrals Quality of Care

Recruitment of Faculty, Staff & Students

Research Funding Publications Consumer Awareness Physician Referrals Patient Referrals Quality of Care

What Influences Rankings?

What Do Rankings Influence?

The University/Hospital Equation: Top Tier Rank

The Financial Perspective

Average support received by all medical schools $51 m

Hospital partner financial support for top 20 COMs $99 m

Hospital partner financial support for top 40 COMs $72 m

Hospital partner financial support for “non elite” COMs $41 m

UPMC support for Univ of Pittsburgh COM $169 m

% of medical school revenue received from hospital partners--elite medical schools

17

What is the FHA Protecting in Tampa?

USF Health invited to join Institute of Health Care Improvement Consortium of 20 Quality Medical Centers (2007)

USF COM among the only medical schools in the country to have two clinical departments in Top 10 in NIH funding (2007) Pediatrics #3 Neurosurgery #9

USF Practice Group among first medical schools to be totally paperless (2008) Southeast representative for NEPSI “Doctors Without Pens”

When USF is able to recruit world class chairs and faculty, Tampa becomes a “health destination site”

Gynecology #25 Urogynecology ENT Top 50 at TGH and Moffitt

Hospital Affiliations Among Top Research Universities

36 of the Top 50 Research Universities have medical colleges

34 of the 36 describe the hospital relationship as “ownership” or “affiliation with strategic alliance” which makes for more control than exists at USF

Of the bottom 30 medical schools in NIH funding, 27 of the 30 are described as community medical colleges, a model in which USF is currently labeled

It would appear that “ownership” per se is less an indicator of success than a “meaningful affiliation” with a University hospital that a) significantly invests in the medical school and b) sets the bar for care in the community

People Are Leaving Tampa to Obtain World Class Healthcare

As part of our discussion with aspirational peers, UPMCrevealed these facts concerning healthcare in Tampa

Many patients leave Tampa for specialized healthcare, especially in cardiology, sports medicine, spine, and specialized radiologic procedures

Very few patients come to Tampa from non-contiguous zip codes for care, except in cancer

This is the model expected of a small community not of a fast growing metropolitan area

Why This Is Important to Tampa

There are no hospitals in the Tampa Bay region other than Moffitt with a national reputation

In many cases, unlike most other communities, the best hospitals have little teaching or University component and in most cases no resident physicians or medical students, eg. Morton Plant Meese, Sarasota Memorial

Many patients assume they must leave the area for the best health care

This has significant implications for the community and the University given the bioscience thrust by other communities in Florida and the new medical schools beginning in Orlando, Miami, and Boca Raton

Pressures To Change

New Florida medical schools Flush with cash The Orlando push

Increasing ACGME emphasis on scholarly and academic activity

NIH funding Cannibalization of RO1 funded researchers by Top

60 medical schools

Source: LCME

ACADEMIC MEDICAL CENTERSResource Growth and Sources

0

10,000

20,000

30,000

40,000

1985-1992 1992-1997 1998-2001 2002-2005 2006-2010

Tuition and Fees

State and Local Appropriations

Other

Federal Research

Other Federal

Revenue From Hospitals

Fiscal Year

$ in Millions

Communities That Have Recognized the Power of an Academic Medical Center

University of Pittsburgh--Presbyterian Hospital University of California, Davis---Sacramento General Hospital Penn State University---Lehigh Valley Hospital University of Alabama, Birmingham University of California, San Diego Ohio State University Case Study--University of Connecticut

Hartford Hospital, main teaching hospital Built 200 bed University hospital in Farmington Both Hartford Hospital and U Conn Hospital excel

U Conn Hospital among Top 15 teaching hospitals (Solucient) Quality of care in Connecticut generally considered among best in

Northeast

Our Hospital Partners - TGH

USF is excluded from many of the profitable and academically important specialties Radiology Pathology Orthopedics Transplant surgery Anesthesiology

The chair conundrum ACGME Implications

Plastic surgery Hand fellowship Orthopedics Radiology Anesthesiology Institutional deficiencies

Our Hospital Partners - MCC

Moffitt actually expends the appropriate dollars from the hospital to research and education, but rather than University activities, the money goes directly to Moffitt

Moffitt “University” as it relates to IP and research indirects

Competitive groups within the same University DIO Surgery OB-GYN Neurosurgery

Our Hospital Partners - ACH

USF only responsible for 8% of the clinical revenue Would like to “own” pediatrics—the DIO model

Openly competitive with TGH USF COM in the middle

Bottom line

USF COM exists for the benefit of the hospitals

Research survival

Chairs and leadership

Will we be a “world class” health care community?

Service and technology

Where have all the patients gone?

OSU Medical Center

COM & Office of Health Sciences

Departments

School of Biomedical Science

School of Allied Medical Professions

School of Public Health

Centers, Programs, & Institutes

OSU Health System

University Hospital

OSU James Cancer

UH East

OSU Harding Behavioral

OSU Ross Heart

Primary Care Network

Specialty Care Network

OSU Medical Center

OSU Physicians

Central College Faculty Practice Plan

Departmental LLCs:

Medical

Surgical

Primary Care

Hospital Based

University

Research Education Patient Care

USN&WR’s “America’s Best Hospitals” OSUMC Rankings: Overall, #Programs

OSUMC0

10

20

30

40

50

2001 2002 2003 2004 20055

6

7

8

9

10

11

12

13

14

15

16

17

Honor Roll Ranking Specialty Programs Ranked

40 4144

28 24

67

6

9

13

1

(99’ data) (00’ data) (01’ data) (02’ data) (03’ data)

It’s Not Just the Hospitals--The Byrd Conundrum

There is no state funded research institute in the country that is on a medical school campus without a reporting relationship to the health science center

Establish the Johnnie B. Byrd, Sr., Alzheimer’s Center and Research Institute as an entity within the University of South Florida, under the authority and oversight of the USF Board of Trustees.

The Byrd Institute’s statewide mission and identity would be maintained and specifically enumerated in statute.

BOT oversight and statutory identity enhances governance and accountability to the Byrd Institute’s founding goals of world class research, treatment, and care-giver support for Alzheimer’s disease.

The Conclusion

USF needs the opportunity to build a small teaching hospital or to partner with an academic hospital entity to create a world-class academic medical center to advance:

The research, clinical and education missions at USF Health and USF

The reputation and needs of the Tampa Bay community as it continues to grow in population and stature

The Conclusion

This is a totally separate issue from blanket CON reform but rather a decision that will affect the state’s medical schools and multi-billion dollar investment

Since there are no top medical schools without a University hospital partnership where the University chairs serve as the hospital leaders, our communities will not see the “academic medical center” advantage

The Conclusion

As a trade organization, the FHA will protect its member hospitals rather than push for increased competition or change

In every community whereby an academic medical center has arisen to “set the bar for care in the community” safety, service and quality have risen across the surviving hospital systems

USF Health is at a crossroads of becoming one of those systems but cannot without a paradigm shift among the hospital systems in Tampa