Monday, May 17, 2010
Change is in the air for medical care in San Diego -- at least north of I-8. Irwin and Joan Jacobs have donated $75 million toward a new $664 million Jacobs Medical Center, which will house a new 245-bed medical tower as well as a cancer-care hospital, advanced surgery unit and maternity and infant care. Federal healthcare reform will also change the landscape. We discuss the impact of both on medical care here.
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. UC San Diego is about a year away from starting construction on a new state-of-the-art hospital on its east campus in La Jolla. University officials say the new Jacobs Medical Center will be built adjacent to UCSD's Thornton Hospital, and will act as a teaching hospital for UCSD's medical students and become a destination for the nation's top medical researchers and physicians. But some critics see another hospital in La Jolla as a bad move for healthcare in San Diego. And the fact that UCSD plans to move some services from its Hillcrest hospital to the new La Jolla location has also raised some eyebrows. Joining us to talk about the new Jacobs Medical Center are my guests. Mr. Tom Jackiewicz, he is CEO of the UC San Diego Medical System. And, Mr. Jackiewicz, welcome.
TOM JACKIEWICZ (CEO, UC San Diego Medical System): Welcome, Maureen. Thank you.
CAVANAUGH: And Michael Williams is president of the Abaris Group, healthcare consultants. Mr. Williams, good morning.
MICHAEL WILLIAMS (President Abaris Group): Greetings.
CAVANAUGH: And we invite our listeners to join the conversation. What do you think about a new hospital being built in La Jolla? Give us a call. Our number is 1-888-895-5727. Mr. Jackiewicz, let me start with you.
CAVANAUGH: First of all, tell us about this new planned facility, how many beds and what kinds of services it will offer.
JACKIEWICZ: Sure. The Jacobs Medical Center is going to be 245 additional beds and it’s going to bring 12 new operating rooms. The hospital’s actually going to have a focus for the – in three areas. It’s going to have a hospital for advanced surgery, a cancer hospital, and then a hospital for women and infants care.
CAVANAUGH: And how is that different from Thornton Hospital, which, I believe, is right next door.
JACKIEWICZ: Right, well, I think we have Thornton Hospital right next door, which is roughly 119 beds and it has some – it focuses today on cancer, some cardiovascular disease, and then we have the Sulpizio Family Cardiovascular Center which is going to open in a year. So we’re going to have some focus today but this will allow us to expand our cancer care as well as bring some advanced surgical things here as well as sort of cohort our women’s and infants’ programs in La Jolla as well.
CAVANAUGH: And it will – will the new facility also be used as a teaching hospital in a way? I saw a phrase ‘from bench to bed.’ That…
CAVANAUGH: What does that mean?
JACKIEWICZ: Well, bench to bedside is actually a term that sort of talks about translational research and what that’s trying to do is take innovations in the newest things in care that are developed in research labs or in clinical research areas and bring those into patient care as quickly as possible to improve the treatment we can provide for our patients. Our goal here with the Jacobs Medical Center and the cardiovascular center and Thornton Hospital is really to make this a center for innovation and sort of cutting edge care and – Because we believe with all the things we have here in San Diego, with the research and the great IT and the terrific faculty that we have, that we can do things here in San Diego that we wouldn’t be able to do in other parts of the country.
CAVANAUGH: Now, I wonder, is the – are your aspirations for this new Jacobs Medical Center in conjunction with Thornton Hospital, which is already there on your campus, that you might be able to create a nationwide healthcare destination up there with Stanford or UCLA, is that feasible?
JACKIEWICZ: That is absolutely feasible. San Diego has so much to offer and we feel like the Jacobs Medical Center is the last piece. And we really see our competition as Stanford and UCSF and UCLA here on the west coast. And we really need – and the Jacobs Medical Center is the final piece in this puzzle where we can create a true academic medical center which really can bring all the things those other medical centers can bring, and bring it here to San Diego. But we’d also like to be a destination center for folks across the country and in the world where we have really the most advanced techniques and the newest innovations, and people come here to get those.
CAVANAUGH: Let me speak – change the subject just a little bit or expand on the subject, if I can…
CAVANAUGH: …with Michael Williams. He’s the, as I say, president of the Abaris Group, healthcare consultants. And, Mike, does San Diego County currently have any top-tier medical facilities like, let’s say, Cleveland Clinic or the Mayo Clinic?
WILLIAMS: Well, San Diego has pockets of excellence in cardiovascular, cancer care, some of which, of course, occur at the university, but not the collection of services you would see at these, what we would call quadrary centers across the country, the ones that have the best of the best, all consolidated and integrated.
CAVANAUGH: What do you call them again?
WILLIAMS: We often think of a primary care hospital, as primary, and then secondary or tertiary hospitals being a hospital that has trauma center capability and advanced capability in neonatal ICU and what have you. But a quadrary hospital, there’s probably less than 50 of those in the country that offer heavily populated services across specialized lines.
CAVANAUGH: So what would be the difference, say, between a Mayo Clinic and just a really good community hospital?
WILLIAMS: Well, the Mayo Clinic, for example, as described by the university, UCSD, would be a facility that would have the research that drives the care given, and in addition to advanced care, all the very unique subspecialists, radiological subspecialists or perhaps surgical subspecialists that you don’t find in each campus dealing with various disease and organs. And then finally, a primary care and secondary specialty clinic network that allows these patients to be drawn in and, more importantly, to be cared for once they leave the hospital setting.
CAVANAUGH: My – Your agency, the Abaris Group, does consulting on a number of healthcare issues for universities and government and so forth, and as you look at the San Diego County community healthcare, do – is it feasible for us to think about having sort of a Mayo Clinic, a Cleveland Clinic, here in San Diego?
WILLIAMS: Most certainly. We actually finished, a few years ago, a study on the healthcare safety net in San Diego County and one of the things we learned, which was not a surprise to most, which San Diego’s the sixth largest county in the country but its reach is much further if you reach out to Imperial Valley and, even to a certain extent, into Orange County and what have you and then perhaps services across the nation as was described, that San Diego would be a perfect opportunity, given the current collection of capability, research and training and what have you.
CAVANAUGH: I’m speaking with Mike Williams. He’s president of the Abaris Group, healthcare consultants. And Tom Jackiewicz, he’s CEO of the UC San Diego Medical System. And we’re talking about UCSD’s plans for the Jacobs Medical Center on their east campus just adjacent to Thornton Hospital. Now, as I say, this, Tom, this facility will be adjacent to Thornton Hospital.
CAVANAUGH: It’s near two Scripps Hospitals, Scripps Memorial and Scripps Green. Sharp’s Mary Birch Hospital is not far away. Do we need a fourth medical center in this same rather small area of San Diego County?
JACKIEWICZ: Maureen, I would say that, I think, the first part of it is, is I think this Jacobs Medical Center is going to be different and it’s really going to bring something different to this community than everything else. And I think the location in La Jolla allows us really to synergize with our campus and with our researchers, both our bioengineers, our IT support and some of our research faculty to really create this academic medical center. I think – And so, too, I don’t look at these beds as being redundant here in San Diego. I actually look at this as added and it’s something new that we’re going to bring and really leverage everything that’s in La Jolla around the research base, whether it’s a stem cell center, it’s, you know, our research partners, or all the great things that are going on at UCSD. I think this is something new and very special for San Diego.
CAVANAUGH: What are your plans for the Hillcrest hospital? I know that you’re downsizing the number of beds slightly and moving some of the services.
JACKIEWICZ: So we really do have a two-campus strategy and Hillcrest is a critical part of that. So at Hillcrest, when the Jacobs Medical Center opens, we want to use that as an opportunity to improve the facility, to make it a more patient-friendly experience, have more private rooms, which are really the expectation of our patients today. So we look at the – Hillcrest as an integral part of our strategy. We’re there through 2030. We’re beginning the planning for post-2030 about a new facility there. So I look at Hillcrest as a critical part of our longterm vision, and Hillcrest is going to provide, you know, trauma, burn, medical-surgical care, psychiatry care, HIV care long into the future.
CAVANAUGH: You are moving your maternity treatment away from Hillcrest, right?
CAVANAUGH: And what else will be making that switch?
JACKIEWICZ: At this point, that’s really the – We are going to try to cohort some programs in both locations so we have some efficiencies. But, really, the women and infants program – and it’s really only for the inpatient care for the delivery pieces and if a baby needs a NICU, that’s really the only part that’s really moving. All our prenatal care is going to stay the same as it is today.
CAVANAUGH: Now UCSD acquired the Hillcrest hospital about – actually about 30 years ago.
CAVANAUGH: It was then a county hospital for mostly poor patients. There have been some accusations, Tom Jackiewicz, that UCSD is backing away now from its commitment to care for poor and uninsured patients by moving some of these services to La Jolla.
JACKIEWICZ: Yeah, that’s really not the case. I mean, part of our mission here in San Diego is to be part of the safety net and we have never, you know, we would never back off on that. And so we’re going to provide the care in Hillcrest and we’re going to – you know, and if a cancer patient is under – is part of the underserved population and needs cancer care, they can get that in La Jolla as well. But our real focus here is to continue to, you know, to provide services to the people that we do to – that we do today. And that’s really part of our longterm mission and vision here in San Diego.
CAVANAUGH: One more question about this, Tom Jackiewicz. Back in 2005, UCSD was – really got a lot of criticism by county supervisors and patient advocates for a plan to move some beds and services from UCSD’s…
CAVANAUGH: …Hillcrest hospital to La Jolla, and basically UCSD decided to back off on that plan. So what’s the difference between this plan and the one back in 2005?
JACKIEWICZ: The real difference here is we have a commitment in Hillcrest. We’re going to be in Hillcrest for the longterm. Hillcrest is an important part of our strategy. I actually personally believe that Hillcrest is really an opportunity for us and I think it’s a place that we need to be in San Diego. So I think that’s – we’ve made a firm commitment to be in Hillcrest in the longterm and, you know, we’re going to obviously live up to that commitment.
CAVANAUGH: Mike Williams, as you study healthcare services in San Diego, I’m wondering, I’m going to pose the same question to you. You know, there are – this new hospital will be the fourth in a very small area of La Jolla. Is this a good way to distribute healthcare services in San Diego do you think?
WILLIAMS: Well, I think it depends on how you consider distribution. In most health – First of all, it’s not unusual in urban environments to have clustering of hospitals in—even competing hospitals for that matter—in locations. Houston, being an example, that we call these ‘pill hills.’ Sort of a slang word for where hospitals are clustered and in some cases there’s fertilization between faculty members and services. But having said that, the new hospital, there’s no conversation that I’ve seen that suggests an emergency department and 50 to 60% of most of the safety net and access points for most patients to a hospital, most of the admissions, for example, 50 to 60% in a community hospital, come through the emergency department so what it appears that UCSD is offering is a – primarily a tertiary service and that tertiary service is commonly found in the clustered area in communities.
CAVANAUGH: And tertiary service, you mean it would be largely made up of specialties.
WILLIAMS: Correct. The deep specialties much like you find at the Mayo and UCSF and Stanford and what have you.
CAVANAUGH: And, Tom Jackiewicz, is there any plan to have any emergency services at the new Jacobs Medical Center?
JACKIEWICZ: So actually what we’re doing as part of our Sulpizio Family Cardiovascular Center, we’re actually doubling the size of our emergency room as part of that building in a year. And so we’ve – so that’s really – so we’re really planning on that expansion within a year which, you know, hopefully will provide all the emergency services, you know, additional emergency services in that area. As part of the Jacobs Medical Center, we don’t actually plan for any additional emergency room capacity.
CAVANAUGH: Now, Mr. Jackiewicz, the crux of the criticism that I’ve heard about the idea of building a new hospital next to Thornton Hospital is that UCSD is courting basically a higher income level of patients, that they, you know, people who have good insurance, people who can pay a lot for medical facilities and sort of backing away from all of the people who need healthcare who can’t pay, who are Medicare patients, who are MediCal patients, who just simply don’t have that kind of money. So how do you answer that criticism?
JACKIEWICZ: So first is we know San Diego County needs additional beds and we projected about 750 new beds by 2020, and there’s going to be about 36,000 more discharges in San Diego County and that’s due to the demographic changes, both the aging of the population plus the growing of the population. You know, we’re going to serve patients across their, if you will, the payer spectrum so we’re not actually, you know, if you will, picking certain patients out that we’re going to serve and others that we’re not going to serve. We’re going to serve people across the spectrum. And so I think that’s – I mean, that’s part of our strategy, so that’s – So, I mean, I don’t think we’re actually targeting – We are not targeting any one particular group. We’re actually targeting – We want patients really from across the, you know, economic spectrum.
CAVANAUGH: And Michael Williams, from your previous comments it seems as if you feel that this new facility may actually affect San Diego County’s safety net? Is that – Did I understand that correctly?
WILLIAMS: Not necessarily because without the emergency department, the safety net patients in Hillcrest, for example, that may have cancer needs or OB/GYN needs would still get that care at their local emergency department. Of course, there’ll still be a trauma center there and what have you. So most teaching hospitals, contrary to what I said about community hospitals, with 50 to 60% of most of their admissions coming through the emergency department, which is where you tend to see the highest number of uninsured and underinsured, most tertiary hospitals, excuse me, the teaching hospitals, their admission rate through their emergency departments is 20 to 30%, so they primarily get their referrals and their admissions through teaching referrals.
CAVANAUGH: Mike, are more specialty medical centers a trend?
WILLIAMS: Well, I think it depends on how you look at it. There was a pretty dramatic move in the nineties and the early 2000s to look at orthopedic hospitals and cardiac hospitals and almost all of those have failed. But in terms of a combined, consolidated and integrated campus with excellent services at the pinnacle of their levels, both cardiovascular, cancer and what have you, and for children and women’s, I think that is a trend.
CAVANAUGH: And what do you think of the medical services in San Diego now? What are some of the positive attributes that you see across the county?
WILLIAMS: Well, San Diego is blessed with not only tremendous in-patient resources but they’re also blessed with just an unbelievable network of outpatient services, including the emergency departments. They’re well dispersed, they’re well organized, they’re state of the art in terms of some of the practices they follow in moving their patients through. And then you have this unbelievably high quality network of community clinics in excess of a hundred sites, the largest per capita I’ve seen anywhere in the country of the places we’ve studied. And all of those will drive towards providing ongoing access to the public in the future.
CAVANAUGH: So what do we need here, according to your study?
WILLIAMS: Well, our study was a few years back but I think we do need as much cooperation as possible between hospital and healthcare systems. Our current system is not set up for that, much like it was set up back in the seventies and eighties where we had health system agencies that were really coordinating and trying to adjudicate collaboratively what services to provide where. And there is a risk of redundancy and duplication if that’s not done carefully.
CAVANAUGH: And, Tom Jackiewicz, talking about the number of beds that you’re adding to San Diego’s healthcare system, what are your expectations on how many more hospital beds San Diego County is going to be needing in the coming years?
JACKIEWICZ: You know, our projection says about 750, which I think may be a little bit on the conservative side considering with healthcare reform now passing. So we feel like we’re making our contribution to the deficit but the Jacobs Medical Center is not going to, you know, is not going to be enough beds to fill that deficit.
CAVANAUGH: And when you say with healthcare reform passing, that means more people will have actually, we believe, access to medical care, is that correct?
JACKIEWICZ: That’s right. I think all of our projections are about to change in terms of the demand for health services.
CAVANAUGH: I’m wondering, Michael, as you look at what’s going to come down the pike with healthcare reform, what other trends do you see in healthcare?
WILLIAMS: Well, virtually all of the population that are eligible and only a few that are not that choose not to participate, in contrast with what the law requires, will have health insurance. So the challenge, of course, is going to be primary care access which we have a deficit of primary care physicians across the country. So there’s a potential for more demand in the emergency departments, longer waits, and what have you, and I think that’s a bit of a problem. But in terms of care, evidence-based clinical care that drives the outcome of patients, the delivery services and the outcome of patients in the acute care setting is going to be a heavy focus that’s been – that will be funded under the healthcare reform, and that’s a good thing.
CAVANAUGH: Michael, some people who have been critical of the new hospital, the new Jacobs Medical Center, going to be constructed in La Jolla, have said, you know, there’s not enough healthcare facilities south of 8 to serve the South Bay. Did you find that in your analysis of San Diego County’s healthcare facilities?
WILLIAMS: Well, we found that there were sufficient resources at the time we did our study and there was a risk that some of those resources would erode if, for example, some of those beds were closed. At one point during the early part of our study—and, again, it’s been about 5 years—there was a risk that three hospitals might actually close or significantly downsize. All of that has been, for the most part, abated and those resources will continue.
CAVANAUGH: And let me ask you, Tom, when will Jacobs Medical Center open for patients?
JACKIEWICZ: It’ll open actually with the first three floors ought to be ready for occupancy at the end of 2015 with floors 4 through 10 ready for occupancy in 2016.
CAVANAUGH: What will this mean for UCSD’s medical school?
JACKIEWICZ: Oh, this is a tremendous addition. I think in terms of being able to expand our services and really getting focused on some of these really high-end services, I think, that an academic medical center can bring will help us attract the best faculty – continue to attract the best faculty, the best students, you know, and I think it’ll probably raise the level of medical care all the way across San Diego.
CAVANAUGH: If, indeed, one of the problems is a lack of primary care doctors, will that be addressed in such a specialized center as the Jacobs Medical Center?
JACKIEWICZ: Well, you know, training primary care doctors, and we’re always concerned about that, about making sure we have enough primary care, you know, one of the things I think right now in terms of there’s – as there’s more debt for students that come out, there’s always a pressure to go into the better reimbursed specialties and so there’s some – as an organizational perspective, we really understand the need for more primary care doctors but at the same point students’ll make choices and we struggle with that sort of give and take all the time. But I do agree with Mike in the sense that with healthcare reform and with more access being created for folks, primary care is going to be a critical issue.
CAVANAUGH: And, Michael Williams, it sounds as if, from your studies of how healthcare is developing across the nation, San Diego is pretty much right on board with its own pill hill and with its own distribution of healthcare facilities. Is that right? Or am I wrong about that?
WILLIAMS: Very much so, and not only that, San Diego operates one of the pinnacle trauma systems in the country, which UCSD Medical Center is a big part of that and they’re really well respected across the country. So in many ways they offer centers of excellence and potentially even enhancing that with the UCSD Thornton campus plan.
CAVANAUGH: Well, I want to thank you both so much for speaking with us today. Mr. Tom Jackiewicz, he’s CEO of UC San Diego Medical System. Thank you, Tom.
JACKIEWICZ: Okay. My pleasure. Any time.
CAVANAUGH: And Michael Williams is president of the Abaris Group healthcare consultants. Mr. Williams, thanks a lot.
WILLIAMS: Thanks. Nice talking with you.
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