Print

New UConn Hospital? Or No UConn Hospital?

Opinion By MYRON GENEL

March 19, 2008

After extensive study, the Connecticut Academy of Science and Engineering released its report to the General Assembly and its recommendations regarding the proposed enlarged replacement for the John Dempsey Hospital at the University of Connecticut Health Care Center in Farmington.

UConn's proposed 352-bed replacement hospital plan was evaluated against the projected statewide need for hospital beds, along with the effect of additional beds at Dempsey on regional hospitals. The committee concluded that, from UConn's perspective, a replacement of the size proposed — or even larger — had considerable merit and could enhance the health center's physical integration of the three pillars of academic medicine: education, research and patient care.

However, the committee was also conscious of the fragile status of health care delivery nationally and in the Greater Hartford region, where hospitals are struggling with inadequate reimbursement, especially from public programs such as Medicaid. The addition of 128 acute-care beds — absent demonstrated need, at least until 2020 — would likely destabilize health care in the region.

Also, even a larger Dempsey hospital would not sufficiently provide a well-rounded clinical education for the university's current class of 80 medical students, not to mention expansion by 10 percent to 20 percent, as is taking place in medical schools across the nation in response to projected physician shortages.

The committee concluded that the status quo was unacceptable. The present 224-bed hospital is too small, and extensive expenditures to revitalize the facility for hospital use cannot be justified. Yet the need to address the inadequacy of the current facility presents an opportunity for the health center and interested regional hospitals to develop a regional academic medical education network that ultimately could enhance health care in the region and throughout the state.

Thus the committee recommends that discussions between the health center and regional hospitals, already under way, should be intensified with the goal of developing strong academic clinical partnerships. This should be carefully monitored by the legislature through appointment of an independent monitor to ensure that the best interests of the state are considered.

These discussions should include closing Dempsey and renovating the vacated space to support the health center's teaching and research. The committee felt, however, there was value in maintaining some mixture of inpatient and/or ambulatory patient care facilities at the health center, but these could be built and operated by a primary clinical partner selected through the affiliation process.

The mixture of inpatient and ambulatory facilities could be determined by careful study of the health care environment and mutual needs of the health center and the selected clinical partner, but in any event these would not be state-operated facilities.

Significantly, this solution removes the health center as a direct competitor with its valuable teaching hospital partners, and provides an environment for enhanced cooperation and collaboration.

The committee recommends an accelerated timeline to develop a common vision and set of guiding principles for establishing sustainable affiliation agreements between the health center and regional hospital partners. To some extent this already exists in pediatrics, through health center's close affiliation with the Connecticut Children's Medical Center. A six-month process would follow, during which the health center and identified clinical partners would define the explicit affiliation relationships, with specific attention to shared governance and financial arrangements.

Since the formation of the health center more than 40 years ago, the relationships envisioned by the committee have not emerged. The committee was mindful of this history, but its recommendations reflect a vision that there exists a unique opportunity to build on the health center's innovative common science curriculum for dental and medical students and to create new, interdisciplinary models of health care education that reflect the current health care delivery system.

If this can be accomplished, the health center and the Greater Hartford region can be at the cutting edge of training for the next generation of health care professionals.