         
|
|
|
|
1st appeared
23 September
1999 REPORT TO UCSF STANFORD HEALTH CARE BOARD ON THE FUTURE OF MOUNT ZION To ensure the future of the UCSF clinical enterprise and the Mount Zion Campus, the UCSF School of Medicine proposes the following key recommendations:
Since its amalgamation into UCSF in 1990, Mount Zion Hospital has become an integral part of our clinical and academic programs. Approximately 110 full time faculty principally utilize the Mount Zion clinical facilities. It is a training site for 89 residents and 15% percent of all UCSF medical student core rotations. The Mount Zion campus is also the primary location of the National Cancer Institute-designated Cancer Center. Less than one year ago, the management of UCSF Stanford Health Care appointed a task force to consider the configuration of clinical programs on the North Campus. The task force’s recommendation, which was endorsed by management, was to work toward building a new inpatient facility on the Mount Zion campus before 2008 when the current hospital buildings would require major upgrades to meet new seismic codes. It was hoped that this new facility would have at its core a children’s hospital, and that the facility would also be an inpatient site for comprehensive cancer care and the patients of community physicians. Earlier this year we were informed of a significant financial loss at UCSF Stanford Health Care. This loss was unexpected because financial reports for the merged clinical enterprise had been very positive until January. A subsequent financial analysis done by the Hunter Group demonstrated that a sizable portion of the loss was at the North Campus and, specifically, Mount Zion Hospital. These losses required a reassessment of all the clinical programs under the auspices of UCSF Stanford Health Care. Because of the major academic impact of any change in clinical configuration, the UCSF Stanford Health Care Board of Directors requested that UCSF make a recommendation to stem the losses. It must be remembered that both the original acquisition of Mount Zion Hospital and the strategic plan of 1998 were predicated on two fundamental assumptions: (1) the limitation of space on the Parnassus campus stunted growth of clinical and academic programs at UCSF to an unacceptable degree; expansion space was necessary to meet expected and appropriate growth; and (2) the financial condition of the UCSF hospitals was sufficiently robust that any investment in programs on the Mount Zion campus could be more than offset by the profitability of the Parnassus campus. Although the second premise is now known to be untrue, we believe that the first premise is as valid now as it was then. The current recommendation is based on an extensive process that sought to determine how UCSF Stanford Health Care could meet its financial needs while, at the same time, preserving and protecting its academic mission as well as creating new academic opportunities. The process included a concerted effort to obtain additional public financial support for Mount Zion that produced no additional revenue. In a town hall meeting this summer, faculty and staff of Mount Zion and members of the community eloquently demonstrated the importance of this century-old facility to patients, physicians, and trainees. At this meeting many excellent ideas were expressed, all of which were taken into consideration. In addition, a special Task Force to Evaluate Clinical Alternatives for UCSF/Mount Zion was appointed by Dean Haile Debas and chaired by Mount Zion Associate Dean Ernest Ring . We appreciate that the uncertainty surrounding the future of Mount Zion has been anxiety provoking and demoralizing to those of us who treasure it. We also want to emphasize that losses at the Mount Zion site are not the fault of faculty, community physicians, or staff, but rather are related to intrinsic inefficiencies in operating a small inpatient service that cares for such a large Medicare and underserved population. With the goal of presenting a comprehensive and carefully considered proposal, UCSF feels that it has responded as promptly as possible. We deeply regret that the financial realities of UCSF Stanford Health Care have necessitated these recommendations. ASSUMPTIONS The financial losses identified at Mount Zion reflect a broader problem with costs and reimbursement for the North Campus as a whole. The UCSF faculty, therefore, sees the current losses not as a "Mount Zion" problem, but as a North Campus issue that must be solved through effective and maximal utilization of both the Mount Zion and Parnassus sites. Several possible solutions were developed based upon the following assumptions:
CONSENSUS PLAN In order to address some of the important issues for the North Campus, Dean Haile Debas met with UCSF School of Medicine clinical department chairs on September 10th to discuss the merger and the financial challenge. A number of proposals, which were developed as a result of the process described above, to redefine the distribution of clinical services and improve our financial position, were considered. After extensive discussion and evaluation of the impact of each of the proposals on the hospital and academic programs, consensus was achieved to recommend that the following plan be implemented:
GUIDING PRINCIPLES There are a number of principles that will guide the process of transferring Mount Zion inpatient services. First, it must be understood that this process requires careful planning and implementation. It cannot be accomplished overnight, and will not have an immediate positive impact on the budget. Second, this plan is a short-term solution. The Mount Zion site, where the UCSF Cancer Center and many outpatient programs are located, is of tremendous importance to UCSF and the community, and its future must be thoughtfully planned. Third, substantial capital expenses will be required for this plan, only some of which are already budgeted (e.g., 11th floor ICU and ED expansion at Parnassus). It is likely that additional capital funds will be needed to execute this plan. The resources will be spent primarily at Parnassus to facilitate integration of inpatient services onto one site. Some capital costs will also be required to improve the ambulatory services at Mount Zion and to support the new outpatient Clinical Cancer Center. Fourth, every effort will be made to ensure that Mount Zion patients and physicians are accommodated as inpatient services are integrated on the Parnassus Campus. Fifth, prior to implementing this plan, educational implications will be defined, and all attempts will be undertaken to minimize adverse effects. Careful consideration must be given to the Memorandum of Understanding between the state and the University of California regarding the distribution of specialty and primary care residents. Any change in the number of residents or potential reduction in primary care positions could impact this agreement. Sixth, these recommendations are made with an understanding of the impact they will have not only on UCSF faculty and trainees, but also on patients, the community, employees, and community physicians. UCSF Stanford Health Care is urged to find ways to mitigate adverse effects on these important constituencies. IMPLEMENTATION STRATEGY The School of Medicine recommends that joint committees of faculty and hospital leaders be appointed to develop short-term implementation plans as well as longer-term strategic plans for the use of both Parnassus and Mount Zion sites. UCSF faculty members who will serve on these two committees have already been identified. The UCSF faculty and staff are committed to improving the financial outlook for the North campus. The plan we have outlined will provide the initial steps toward redefining inpatient and outpatient services that ensure the financial viability of UCSF Stanford Health Care and the future of UCSF academic programs and maintaining long term access to quality health care for our patients. Submitted by:
Dean Haile T. Debas
Daybreak story: Inpatient and Emergency Services to be Transferred from Mount Zion |
||
|
DAYBREAK | ARCHIVES | CALENDAR
| CAMPUS NOTES Copyright ©1999 Regents
of the University of California. All rights reserved. |
||
