Medical Center plans expansion

and JORIE GREEN The University's Medical Center will be forced to expand in order for the Medical School to remain an academic leader under Clinton's healthcare plan, Center officials said yesterday. Expansion is also necessary for the Hospital of the University of Pennsylvania to remain financially viable. Under President Clinton's healthcare plan, "you become a big player [in regional health-care], or you're probably dead," Medical Center Vice President Gordon Williams said yesterday. "You play, or you're in big trouble." Medical Center Chief Executive Officer William Kelley said he expects the health care systems of other large universities – such as Johns Hopkins University, Harvard University, Yale University and the University of California-San Francisco – will emerge as major players in their regions. The University will attempt to become one of the region's major healthcare providers, potentially responsible for the healthcare of up to 600,000 Delaware County residents, Kelley added. In order to take care of that many people, the University is currently in the process of purchasing the practices of primary-care physicians – general internists, pediatricians and obstetricians – throughout the greater Philadelphia area. The University plans to buy out the practices of 100 to 200 primary-care physicians, and may bring another 500, whose practices the University would not own, on board as affiliated staff, Medical Center Vice President Wilbur Pittinger said yesterday. Doctors whose practices are bought by the University would become employees of the University's healthcare system and adjunct Medical School faculty, he said. A central management office would handle billing and scheduling for doctors in the University network. Under the Clinton plan, which will be sent to Congress within the next seven to 10 days, health-care providers will be expected to provide all levels of health-care, from checkups to hospitalization. Currently, the University, through HUP, provides only late-stage care – when a patient becomes so sick or hurt that he or she needs to go to a hospital. In a managed-care environment, which the Clinton plan will mandate, primary-care physicians will serve as the feeder for hospitals. Without primary-care physicians on board to serve as HUP's feeder, the Medical School's capacity to teach will be seriously compromised, Pittinger said. "You can't teach a physician or a nurse-in-training over an empty bed, or in an empty examining room," he said. Williams said that in the Midwest and on the West Coast, where managed-care began to catch on several years ago, university hospitals that did not participate were muscled out of their regional markets. And several of these hospitals have since experienced serious financial problems, because they are treating so many fewer patients. Pittinger said not participating in managed care means risking the Medical Center, which currently has assets of roughly $1 billion. "To do nothing means that the University is prepared to risk $1 billion worth of assets," he said. "To do something is to say that we have a chance of protecting these assets." According to Kelley, the outpatient-care facility the University plans to build on the current site of the Civic Center figures prominently into managed-care. The point of managed care is to force healthcare providers, whose revenue comes in the form of annual premiums payed by insurees or their employers, to provide the most cost-effective care. It is far less costly for hospitals to treat outpatients than to keep patients in the hospital, Kelley said. Under a managed care system, it would be in a healthcare system's best interests to treat as many people as outpatients as possible, keeping patients in the hospital only when absolutely necessary. The University hopes to break ground for the facility in 1995, with an opening date in 1998, Kelley said. And the new HUP might actually have fewer patient beds than the current HUP facility, Kelley said. Nurse practitioners will also be a major part of managed care, because it is more cost effective for a health care provider to have nurse practitioners administer physicals and injections and perform procedures such as stitches than to have doctors perform the same procedures, Williams said. The University plans to have a substantial number of nurse practitioners become part of the primary-care network, although Pittinger said the exact number had not yet been decided.

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