Recalibrating the plan: Exceeding all projections, UK HealthCare is well positioned to meet Top 20 goal
A message from Dr. Karpf - July 2008
- Strategic Plan
- Academic Planning
- Recalibrating the Plan – Moving Forward 2009 to 2013
Five years ago, President Lee Todd realized that to transform the University of Kentucky into a top 20 public research institution as mandated by House Bill 1, our academic medical center has to be at the forefront of this advance. At the time, President Todd also understood that the hospital was losing market share and the College of Medicine was having difficulty retaining and recruiting critical faculty. Change was necessary.
In response, Dr. Todd created the position of Executive Vice President for Health Affairs (EVPHA) to emphasize the need to coordinate and coalesce all of the clinical efforts of the College of Medicine, the practice plans, the hospital and the other colleges of the academic medical center (Dentistry, Pharmacy, Health Sciences, Public Health and Nursing). Having been recruited as the first EVPHA, I felt it was important to reinvigorate and reengage governance, set a clear vision for the institution and define specific goals and tactics.
The University of Kentucky Board of Trustees Hospital Committee was reorganized as the University Health Care Committee in order to emphasize its broader responsibilities across all elements of the academic medical center. Three community participants were added to the committee to further engage the community as well as bring additional expertise to the committee.
A broadly based UK HealthCare Advisory Board was created to energize and engage faculty and staff. This group, which meets quarterly, is comprised of the deans of the six health-related colleges, clinical chairs in the College of Medicine, several senior clinical faculty, representatives of the basic sciences and senior administrators.
The UK HealthCare Executive Committee was created beneath the UK HealthCare Advisory Board to allow more timely and detailed analysis and oversight. This committee met two to three hours per week the first three years. The Executive Committee was given a broad mandate and responsibility to review and comment on all financial, strategic, facility and academic matters. A fundamental precept was that this Executive Committee would have access to every financial number available, thereby insuring total transparency across the hospital, the College of Medicine and the practice plans.
Once these groups were formed, it was important to make sure they committed to a vision and specific tactics to accomplish that vision. The institution went through coordinated strategic, facility, financial and academic planning. All of these planning processes were collated and coordinated so that they supported each other, and the plan for UK HealthCare to move forward was created. Our success over the last five years has dramatically exceeded any of our expectations. In this communication I will review what we have accomplished, and I will describe how we must recalibrate the goals for the next five years.
During the strategic planning process we asked ourselves what UK HealthCare had to do to appropriately fulfill its role in the health care system of the Commonwealth and what strategic success factors needed to be addressed. First, we recognized we are the region’s provider of the most advanced subspecialty care and it is our job to provide all Kentuckians access to the very best of advanced medical care available in the country. Second, as we emphasized subspecialty care on campus, we realized we need to support regional health care providers through organized outreach clinics and other activities. We also came to understand that as we approached those two strategic goals, we must stay committed to efficiency, quality, patient safety and service.
View the Strategic Plan: UK HealthCare: Growing to Serve Kentucky 2004-2020 (PDF, 748 Kb)
A key to becoming the region’s provider of advanced subspecialty care has been faculty retention and recruitment. We have been extraordinarily successful at recruiting outstanding physicians from around the country as well as developing Kentuckians into nationally recognized clinical leaders. Both strategies are necessary as we fill gaps in our ability to provide advanced subspecialty care. The faculty has grown by more than 15 percent since 2004. We now have more than 880 faculty in the College of Medicine. We must continue to recruit in very specific subspecialty areas so that we can achieve the depth and breadth of expertise needed to be a Top 20 medical center.
The strategic plan identified a handful of programmatic priorities and our success in faculty recruitment and retention has helped these targeted areas see real progress. These focus areas are cancer, digestive health, neurosciences, orthopedics and sports medicine, cardiovascular medicine and pediatrics. Additionally, we have intensified and expanded our efforts in transplantation. Each of these clinical areas have seen marked improvement in market share signifying that UK HealthCare has truly become recognized as a provider of advanced subspecialty services for the region.
After much discussion we realized we must support regional providers because they are very important to their communities from both a health care and economic perspective. Most people want to stay close to home for health care for as long as possible to be near their families and friends. Staying close to home supports providers who are often major economic drivers in their communities and also keeps patients in lower-cost facilities. To this end, we have enhanced our commitment to sending our physicians to Kentucky’s communities to work with local medical staff and hospitals to provide a broader array of services closer to home for the people of Kentucky.
In addition to outreach clinics, we have established more formal affiliate networks of providers for the Markey Cancer Center, the Gill Heart Institute and the Kentucky Children’s Hospital. These affiliations enable us to work with local providers in a more comprehensive way to provide subspecialty care at a local level. We have even explored a model of community divisions where we recruit individuals who work predominantly in the community but are given full-time UK faculty status. These individuals receive back-up support from their fellow faculty members and stay engaged with the university spending some limited time clinically on campus and participating in teaching and clinical research.
We came to realize that our geographic expansion through these outreach activities is critical to ensure access to a population sufficient to support advanced subspecialty care. The success of our efforts in Lexington will not and cannot be possible if Kentucky’s regional health care providers do not refer to us their sickest and most complex patients.
Consequently, we are now focusing on trying to develop a virtual network which spans a population of more than 2 million people. In this network, patients will stay close to home for as long as possible and come to Lexington when they need the services of a tertiary and quaternary health care facility. We understand that this is not only good public policy but also makes good business sense. As an example, we are striving to reach 100 kidney transplants a year, the threshold for Centers of Excellence in Kidney Transplantation. To reach this goal, we need to draw patients from a population of over 2 million people based on the kidney transplantation rate in the United States of 56 per million people.
Efficiency, Quality, Safety and Service
In our clinical operation, efficiency, quality, patient safety and service have been a fundamental focus. We were pleased when our organizational efforts were recognized nationally by the University HealthSystem Consortium with their 2007 Rising Star Award as Top Performer in Quality Improvement. We also have been recognized as a Thomson 100 Top Hospital for three years running, only one of 15 academic medical centers noted in 2008. All of you contributed in a significant way on a daily basis by providing the highest quality of care and the best service possible to garner this national award. Thank you for your efforts.
The success of our strategic plan has led to truly unanticipated growth in clinical activity. From a low point of just over 19,000 admissions in fiscal year 2003, we have grown dramatically and have finished fiscal year 2008 just short of 33,000 admissions, a growth of about 70 percent. I certainly never anticipated or predicted this magnitude of growth.
Our market share has grown in all of the targeted subspecialty areas and it has grown from all of our service areas. Our market share of Medicare patients and commercial patients has expanded dramatically. Because of this growth we have moved from being a relativity small academic medical center (around the 25th percentile) to a large academic medical center (now approaching or exceeding the 75th percentile) when compared to other academic medical centers in the United States. The transformation has been critical for us. Small academic medical centers can aspire to but have little hope of becoming Top 20 public research institutions. Academic medical centers of the 75th percentile truly have the breadth and depth to not only aspire to but actually become leading health facilities in the country.
We have made remarkable progress in renovating and expanding our facilities. This work began with the development of a facilities master plan in 2004 that identified our need for a replacement hospital and contemplated the development of the academic medical center campus west of Limestone.
The new patient care facility is rapidly becoming a reality. As the organization has grown over the past four years, the master plan has evolved and the first phase of the hospital project has been modified to include a second patient care tower and two additional floors. Early on in the process we also quickly realized that we needed to build two additional floors in the new parking structure to ensure that we would always have ample parking for our patients and their families. This garage is now open and has been a great success in offering safe and convenient parking for patients and visitors.
With the ever-present pressure to open the entire new patient care facility sooner rather than later, increased funding through philanthropy will play a major role in finishing this building. Thanks to donor support, the auditorium, chapel, health education center, surgical waiting area and gift shop will open in the first phase of the new building along with the originally planned patient floors and emergency department.
Phase 1a, which builds 1.2 million square feet and fits out just short of 600,000 square feet, is totally defined and under construction, and we can now begin planning and financing the remainder of the fit-out of the new building – Phase 1b.
As the clinical activities increased our financial position has strengthened. The hospital budget in 2004 was just over 300 million dollars and has grown substantially. The budget for hospital operations combining Chandler and Good Samaritan for fiscal year 2009 approaches 800 million dollars. Our operational bottom lines have stayed strong with an operational gain for fiscal year 2008 of approximately 45 million dollars. We have, as we promised the Kentucky General Assembly and the University of Kentucky Board of Trustees, been able to accumulate sufficient dollars to finance Phase 1A from operations and the 250 million dollars that we received from issuing bonds.
It has been rewarding to see that as clinical activity has improved, so has our academic production. We have had a record number of applicants to our medical school, our training programs are filling with attractive residents, and our research efforts have expanded in a tough environment for federal funding. The NIH budget funding for the College of Medicine has been projected to top 72 million dollars in 2008, up from just over 50 million dollars in 2001. We continue to push upward in the rankings of top medical centers in terms of research dollars.
The academic campus of the future is now becoming the academic campus of today. The College of Pharmacy building is under construction and steel will be topped out in early August. College of Medicine administrative offices have moved to the Leader Avenue building which previously housed KMSF. There is a consensus on campus that BBSRB II, the next major research facility, must be the top priority of the university for state funding to enhance our overall ability to become a Top 20 public research university. We will shortly initiate a fund-raising effort to catalyze the development of the shared learning facility for the academic medical center. This facility is effectively referred to as the ‘Icon Building’ as it will become the visual centerpiece of the new academic medical center campus.
RECALIBRATING THE PLAN – MOVING FORWARD 2009 TO 2013
As we look back over the last five years and appreciate all we have accomplished, we must recognize that recalibrating our goals for the next five years is critical. We want to confirm our successes and make sure they can serve as the base for a future that guarantees the University of Kentucky will always have one of the truly outstanding academic medical centers in this country. Faculty recruitment will always be a priority moving forward. We have a critical mass of faculty, physicians, and researchers; however, we need to stay focused on expanding the scope and breadth of our services and therefore bring in, in a very targeted way, additional nationally recognized subspecialists. We anticipate recruiting more than 45 additional faculty in the coming year and expect to recruit an additional 75 to 100 faculty by 2013. These faculty members will further support our goal of being recognized as the region’s provider of advanced subspecialty care.
The increased faculty will also support the pursuit of our research agenda, helping us work toward our goal of 90 million dollars in NIH funding by 2013. In order to achieve that goal we must add state-of-the-art research space to accommodate the growth. We have initial concepts developed for the next major research building for the University of Kentucky. It will be sited on Virginia Avenue forming a quadrangle with BBSRB and the new College of Pharmacy building. The Provost and I understand the importance of this next major research facility in moving the University of Kentucky towards Top 20 status. As already mentioned, it is our highest priority for the next legislative funding session.
Moving forward, we must also work to mature the many relationships we have established with Kentucky’s regional health care providers. Our outreach clinics and affiliate networks support the health care services in Kentucky and help us reach a population of patients large enough to support our subspecialists. We will work over the next five years to strengthen the relationships we have built and explore new relationships. As we mature these and other new relationships, we need to ensure we preserve our financial resources. We will not seek to acquire bricks and mortar. However, some relationships may require focused mergers or acquisitions as health care in Kentucky evolves if such is the desire of the partnering organization and if it makes sense for us. As an advanced subspecialty provider we also must begin to look beyond the boundaries of the Commonwealth of Kentucky towards West Virginia, southern Ohio and western Tennessee.
Finally, we must further our facilities planning and construction. Phase 1a of the new building project is now well defined. We are working diligently to refine our plans for Phase 1b and develop a financing scheme. In order to complete Phase 1b in a reasonable time frame, we recognize we will need support from the community in terms of philanthropy and may potentially consider issuing additional debt. We will pursue Phase 1b aggressively so all hospital operations can be moved out of the old hospital building as soon as possible. Moving out of the old hospital sooner could potentially save tens of millions of dollars in cost escalations of construction and operational expenses.
We must begin conceptualizing Phase 2 of the facilities master plan, the expansion of the Kentucky Children’s Hospital in the Critical Care Center tower. Additionally, we need to think further about the next step in the master plan, Phase 3, the razing of the original Chandler Hospital building and the construction of additional clinical space on that site. With the growth UK HealthCare has experienced, it is clear that UK HealthCare Good Samaritan Hospital will will house a significant share of the health care services we provide through the successful completion of these phases of construction.
We must continue to emphasize our efforts in cost containment and enhance our commitment to quality, safety and patient service. To be successful in these areas, we must have the complete support and engagement of faculty and staff. We have recently reorganized our operations under a model of a chief clinical officer who is responsible for coordinating and integrating all clinical activities at UK HealthCare across the spectrum of inpatient and outpatient care. Dr. Richard Lofgren has graciously accepted the responsibilities for this new position. He is putting together a team of physician administrators who will work together with our operational team to make sure there is physician engagement, input, buy-in and cooperation as we move to streamline our clinical care by eliminating unnecessary variance. Our fundamental philosophy is that efficiency and quality go hand-in-hand. We will always commit to the highest level of care, but we do think that when careful process improvement techniques are used both quality and efficiency benefit.
As we move forward toward 2013, UK HealthCare and the entire UK medical center will continue to grow and change. We anticipate that by 2013 we will approach 36,000 discharges. Given that our actual growth has exceeded all of our projections to date, I suspect we may exceed that number substantially. We are also presently engaged in reorganizing our ambulatory care services both physically and organizationally. A number of space changes will be made in the Kentucky Clinic and a number of organizational improvements will occur. We are presently recruiting for a Chief Operating Officer for Ambulatory Care and that individual will report to Jay Perman, MD, the dean of the College of Medicine, and also to Dr. Lofgren. This individual will work to ensure inpatient and outpatient activities are fully coordinated and streamlined. I am quite certain that our relationships with community and regional providers will continue to mature.
I think it is critical to understand that we are no longer a hospital or a College of Medicine or a practice plan. What we are very rapidly becoming and what we must mature into is a health care delivery system that serves the Commonwealth of Kentucky in an efficient, high-quality way and guarantees access to the very best care. This enterprise will emphasize services in the most cost-effective location. When possible those services should occur in the community. When patients must be referred to Lexington, our ambulatory care services must be efficient and coordinated with the local providers. In this construct, inpatient care is just part of the continuum of the seamless system we must develop. In the future, we will also have to look at how we provide post-hospital services.
These last five years have been truly more successful and rewarding than I could have ever imagined; however, I firmly believe it is the next five years that will be critical to hardwiring all of the gains we have achieved and make us an institution so strong and so critical to the health care needs of the Commonwealth that our success is guaranteed for the long haul.
As we move forward we will continue, as we have in the past, to ever refine our goals. I would be remiss if I did not recognize and acknowledge the tremendous work that has been necessary to achieve our successes. Every one of you, from faculty to staff to volunteers, has helped us move forward. Let me thank you publicly and profusely. I am proud of you and I hope you are proud of UK HealthCare…an organization that you as a group have created.
Michael Karpf, MD
Executive Vice President for Health Affairs
Dr. Karpf's Previous Messages
A Message from Dr. Karpf - February 2008
A Four Year Retrospective and a Look Toward the Future
A Message from Dr. Karpf - August 2007
A Four Year Retrospective
A Message from Dr. Karpf - February 2007
Recap of Open Forum
A Message from Dr. Karpf - May 2006
Report on third quarter of fiscal year 2006