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Outsourcing The Hospital

T S. ROSSON, M.D

December 27, 2009

A month ago, University of Connecticut leaders pulled the plug on a proposal by Hartford Hospital to merge with the UConn Health Center to form a first-rate medical school/hospital complex. Under this plan, the state was to build a new hospital in Farmington to be owned and operated by Hartford Hospital. The Hartford Healthcare Corp. would have assumed financial responsibility for the new University Hospital, except for $13 million in annual labor costs to be borne by the state. The other community hospitals in Greater Hartford would continue to participate in the teaching and research activities of the medical school.

Now the situation has reverted to that of 18 months ago. The John Dempsey Hospital will remain too small to be financially profitable, and the state will continue to be responsible for an annual deficit of about $20 million. Moreover, the 32-year-old hospital is said to be in need of major renovations. No alternative plan has come from UConn or the legislature. The question is where we go from here with this unsustainable situation.

In the Hartford Courant of Dec. 6, two state legislators proposed that the Veterans Administration partner with UConn as a way to solve the problem. I don't think this is a viable proposal.

The Newington VA Hospital, which already has an affiliation with the health center, was reduced to an outpatient facility in recent years. Its inpatients were transferred to the West Haven VA, which is a major affiliate of Yale Medical School. While the VA does provide salaries and space for residents and faculty at many medical schools, I do not know whether it can provide operating expenses for university hospitals or funds to build new non-VA hospitals.

I would suggest that UConn visit (or revisit) the idea of a "distributed model" of medical schoolhospital relationships, sometimes known as the "Harvard model". This system is one in which a university medical school has neither a hospital it owns nor one with which it is intimately aligned, but rather uses various hospitals and other medical facilities within its geographic area for teaching students, residents and fellows, and for patient care and research by its faculty. A number of public medical schools, including Florida State, LSU and Michigan State, are examples of this model.

I suggest the following:

•The legislature and UConn should appoint a joint commission to study this possibility. Representatives should visit one or more of the distributed medical schools to learn in detail how the system works.

•UConn should engage a consultant with expertise in the distributed model to determine the efficacy and implementation of such a system in Greater Hartford.

•Under this proposal, the John Dempsey Hospital would close its inpatient services.

The hospital would be retrofitted to include research laboratories, outpatient clinics, outpatient surgical centers, a walk-in center, and a triage emergency center. Last week, Sen. Christopher Dodd added a $100 million item to the health care bill for construction of a hospital at a public university. If UConn receives this money, hardly a sure thing, the best use of it may be to retrofit the hospital.

Under the new configuration, patients needing admission could be rapidly transferred to one of the cooperating community hospitals.

The participating hospitals would provide laboratory and office space and designated hospital beds to the university physicians. Consultations among the university and community physicians would work to the benefit of both groups and their patients. Each group would contribute significantly to the education of medical students, residents and fellows, who would continue to rotate among the hospitals as they do now.

Obviously many financial and administrative problems would have to be worked out before such a plan could go into effect. With, however, strong, enlightened leadership and open-minded good will among the various players, the University of Connecticut-Greater Hartford Medical Center could become the first-rate system of education and medical care the citizens of Connecticut deserve.

If UConn can become first class in basketball and football, it ought to be able to do so in medical education, research and patient care.