University of Kentucky HealthCare is becoming a major medical destination for Kentuckians and also for people living on our borders who need everything from kidney and liver transplants to heart and lung procedures — and everything in between.
And UK doesn’t want to stop there; it intends to become one of the leading integrated academic medical centers in the United States.
UK has made strides since 2004. At that time, the health-care system was seeing a steady decline in clinical activity and was losing relevance in the Kentucky marketplace.
“The College of Medicine was losing faculty, and the hospital was losing market share. It was slipping,” said Dr. Michael Karpf, executive vice president for Health Affairs. “(Former UK president) Lee Todd understood that if the university was to become a major research institution, the academic medical center needed to be at the forefront of that.”
Karpf was hired in October 2003 to correct deficiencies. He thought there was poor communication between the medical faculty, hospital administrators and the dean. “My job was to get them all together and get them to the same place with a common vision,” he recalled.
A 2004 strategic plan was formed. It called for UK to grow in more complex subspecialty care, including organ transplantation, advanced neurosciences, advanced surgery and cardiovascular services.
Why tackle “the hard stuff,” as Karpf refers to it?
“Because if we didn’t do it, it wouldn’t be available to half of Kentucky,” he explained.
Another part of the strategic plan called for more regional partnerships by taking UK HealthCare out into the region to augment specialty services provided by health-care systems and hospitals like Appalachian Regional Healthcare, St. Clair Regional Medical Center in Morehead, Ky., and Rockcastle Regional Hospital in Mount Vernon, Ky.
“Most people want to stay close to home for care. It’s appropriate to keep low-acuity patients in lower-cost facilities,” said Karpf. “Those providers are smaller than us, but are still major economic engines in their own counties.”
This plan helps smaller hospitals stay solvent while expanding their offerings through UK.
The third component of the strategic plan was more emphasis on efficiency, quality and patient safety.
The next strategic plan, 2010-2015, called for UK HealthCare to expand even farther out, to more of West Virginia, southern Ohio and eastern Tennessee.
“We’re convinced that in the next 10 years, the country will have 40-75 regional medical referral centers that do all the high-end stuff,” said Karpf.
A referral center is where patients at smaller hospitals or clinics are sent to handle their major heart, lung, kidney and liver issues.
“Folks that just dabble at it will get out of the business,” predicted Karpf. “Those who do it, must do it well.”
Karpf produced a map of the region that showed other health-care referral centers such as Cleveland Clinic, Ohio State University, Vanderbilt University and Indiana University.
“If we can’t supply these services (for liver transplants, brain tumors, bone-marrow transplants, etc.), these centers will cannibalize our Kentucky patient base,” he said. “Those patients will have to go farther away, or they’re not going to get the services.”
UK wants to get a reasonable portion of the patients in a geographic area of 7-8 million people.
The financial investment has been enormous. From FY 2004 to FY 2012, UK HealthCare estimates it invested nearly $1.4 billion for building construction, equipment and program support.
“Three-hundred and fifty million dollars of that came from bonds that we’ll pay off. Some came from profits (revenues in excess of expenses), and some from an expanded hospital budget,” said Karpf.
UK HealthCare seems on its way to reaching its goals. Fantastic growth is seen in the number of patient discharges in fiscal years 2004-2012. They went up from 19,098 per year to 34,453, or more than 80 percent. Local market share nearly doubled in that timeframe.
“We brought in more patients locally and regionally. Many kids were leaving because pediatrics wasn’t strong enough. We made it stronger, and they stayed,” Karpf said.
According to UK, it is dominant in cancer care (Markey Cancer Center), it has doubled its market share in cardiovascular care in eight years, and it wins the most market share in all neuroscience cases by a two-to-one margin. UK also has 73 percent market share in trauma care and 71 percent in pediatric care.
“Our focus is to do the stuff the ‘big boys’ do, because no one else (here) will do it if we don’t,” Karpf suggested.
The Counsel of Teaching Hospitals (COTH) ranked UK HealthCare 40th in the nation in discharge benchmarking in 2010. That’s up from 85th place nine years ago. Number one is New York-Presbyterian Hospital, rated one of the most comprehensive university hospitals in the world. And while UK HealthCare may never reach the size and status of that New York City hospital, UK would be quite pleased to be the dominant health-care provider in its own region of the country.