The University of Texas Medical School at Houston The University of Texas Medical School at Houston
April 11, 2009 | from the Office of Dean Giuseppe Colasurdo

Distributed on Fridays via e-mail to all Medical School employees, students, residents, and postdoctoral fellows, UT 2 Me is Dean Giuseppe Colasurdo's weekly update of news and items of interest. He also welcomes feedback through this two-way communication.

Hello,
I hope you are having a great Easter weekend. This has been a productive spring week. You are well aware that spring means budget season at the Medical School, and our department budget meetings continue to go well. I’d like to thank Angela Hintzel, Nancy McNiel, Julie Page, Jorge Zambra, Andrew Casas, Kevin Dillon, and their staffs for leading this important process.

I want to thank the Department of Internal Medicine leadership, which is implementing some very important changes involving communications and accountability to eliminate resident duty-hour violations. Such strategic planning is part of the budgeting process, which also includes carefully monitoring unfunded research in light of tight budgets. In this spirit, I have asked departments to reduce unnecessary expenses that will not impact our teaching program, high quality research, or patient care.

Compliance issues remain critical to the healthy functioning of our departments. While we have made significant improvements in this area over the last few years, we cannot afford even one violation. I encourage departments to address this issue and to be open to the suggestions of the compliance team put in place by the president and Kevin Dillon.

I had the opportunity to travel to Austin this week for an outreach visit with our alumni and parents. It was a very well attended event, and I thank Dr. Mark Chassay, ’92, for hosting us, and Dr. John Green, ’79, the incoming president of the alumni association. It is always refreshing to visit with alumni, parents, and students, and they were truly appreciative of hearing the good news of the Medical School in person.

Speaking of alumni, are there any alumni musicians in the house? Dr. Marc Rhoads, professor of pediatric gastroenterology, will be performing as an alumnus and a band member at Johns Hopkins’ upcoming reunion. It would be great for us to have an alumni band at our next reunion, so please let me or Dr. Rhoads if the stage is calling your name.

I am looking forward to welcoming Dr. Guy Clifton back to the Medical School this spring in a new role. In addition to his faculty appointment in the Department of Neurosurgery, Dr. Clifton will be helping the Medical School coordinate new programs with its hospital partners to address and lead the future of health care in the city and the country.

Also looking ahead, Dr. Ken Shine, executive vice chancellor for health affairs, will come for his annual visit of the Health Science Center next week. I cannot wait to share the good news of our school with him, and I will give you a report of his visit.

I participated in several meetings this week focused on promoting collaboration between the Medical School and its partners. I met with Dean Catherine Flaitz; Joe Morrow, director of finance at the Dental Branch; Arlene Staller, vice president and chief legal and compliance officer; and Craig Cordola, CEO of Children’s Memorial Hermann Hospital, to talk about initiatives to reach out to children who have challenges accessing basic medical and dental services. We will further explore this community service and identify funds for this program. Co-branding/marketing was the topic of a meeting with Juanita Romans, CEO of Memorial Hermann - TMC; David Bradshaw, Memorial Hermann chief information and marketing officer; and Beth Sartori, Memorial Hermann marketing and communications executive. I am thankful to Memorial Hermann and Latitude for their elegant analysis, which brought forth interesting concepts to further our marketing campaign with UT Physicians and Memorial Hermann. President Larry Kaiser is strongly supportive of this initiative, and we will make sure these efforts are integrated with the marketing efforts of the Health Science Center.

In the spirit of collaboration and partnership, Craig Cordola has been instrumental as we focus on the budgets of obstetrics/gynecology, pediatric surgery, and pediatrics. I want to thank Craig for the great work he does as a leader – in addition to robust growth, all three of these programs stand up nationally in terms of the quality of care.

The Medical School and Baylor College of Medicine held a very collegial joint meeting with the Affiliated Medical Services (AMS) board to discuss how we can continue to support and expand access to specialties at the Harris County Hospital District. We look forward to furthering our discussion about a joint strategic plan to serve this population. This week, Dr. Steve Brown, associate dean for Harris County programs, tackles six questions to address the importance of the relationship of the Medical School and HCHD.

1.       What are the top three objectives of your office?
To assist UT staff at the Lyndon B. Johnson General Hospital (LBJGH) with Harris County Hospital District (HCHD) operational issues relating to clinical care, research, and education, including maintaining an environment conducive to the education and training of young professionals, such as operating a Transitional Year Residency Program, providing educational spaces with teleconference capabilities, and providing IT technical support onsite.

To collaborate with the HCHD administration on issues relating to faculty and resident funding, the provision of high value care, and external regulatory standards.

To provide high quality health care onsite to the inmates of the Harris County Sheriff’s jail.

2.       How do the goals of your office support the mission and goals of the Medical School?
The Office of Harris County Programs facilitates funding and coordination of clinical and educational resources; approval and oversight of approximately 100 research protocols in concert with the HCHD and M. D. Anderson; and collaboration with the HCHD and the Harris County Sheriff’s Office on quality improvement and standard-of-care issues to assure providing “exemplary clinical services” for the diverse population of Harris County.

In cooperation with the HCHD, the office seeks to improve processes and facilities that directly impact the training environment, including provision of state-of-the-art video conferencing to support bilateral transmission of conferences with the Medical School and the continued development of the 17,500-square-foot space known as the LBJGH East Wing to encourage the growth of an onsite contingent of consistent faculty, a key step in the maturation of an academic hospital.

The multicultural faculty, medical school class, and postgraduate trainees of the UT Medical School serve an equally diverse population at LBJ General Hospital. The diverse patient population brings an extraordinarily broad spectrum of clinical experience that includes tropical infectious diseases and illnesses thought to be of bygone days, such as a case of tuberculosis that mimicked esophageal carcinoma or syphilitic aortitis, in addition to more common processes that UT trainees will treat throughout their careers. Treatment of these unusual and common diseases requires consideration of cultural beliefs and practices, and this broadens the trainees’ perspective while engendering respect for other cultures. As Texas’ cultural diversity expands, LBJGH will continue to have a unique role in the UT Medical School’s portfolio of clinical education well into the future.  In partnership with the HCHD, the hospital and its associated clinics are emerging as major teaching and research facilities that provide care to all, including those who can least afford care.

LBJGH and its associated clinics provide 25-50 percent of the UT-H medical student clinical education, depending on department, and served as a primary site to justify the recent Medical School class enlargement to 232.

Advocacy coordinated through the Office of Harris County Programs nearly doubled the number of GME positions supported by the HCHD from 1991 levels to the current 216, or 28 percent of all UT-H GME positions, an increase of 13 in the past year alone.

The Office of Harris County Programs supports the highly competitive Transitional Year program with 13 residents annually.
 
3.       What are you doing differently in your office this year? What is new?
1) The major change this year is the new Affiliated Medical Service (AMS) contract that funds UT Medical School faculty and graduate medical education (GME) trainees providing care in the HCHD facilities.  Although the administration of the new contract is more complex that the previous, it is estimated to have increased revenue by at least $6M for faculty compared to the previous year but also expects faculty clinical productivity at national academic benchmark levels.  The office is working closely with the Medical School’s business office, each department, and the HCHD to ensure efficient operation of the contract and compliance with its terms while also working with the HCHD to ensure that our faculty have an efficient care environment.

2) The LBJGH chief of staff instituted regular meetings with representatives of the housestaff to hear that group’s concerns and discover impediments to patient throughput.  Similarly, the LBJGH chief of staff instituted monthly meetings with the LBJGH administrator and chief nursing officer to review candidly operational issues for both the HCHD and UT-H.  

3) The Office of Harris County Programs is coordinating the medical staff’s participation in the design of the new $64 million, 83,000 square foot ambulatory surgery and clinic building that will be built immediately west of LBJGH by 2013.

4.       What role will your office play in the future of the Medical School?
LBJGH is a crucial part of the UT Medical School’s future.  The challenges of limited resources and a growing uninsured population, which all public hospitals face, encourage the development and use of high value evidence-based care systems.  These pressures teach critical thinking and collaboration to UT’s trainees and faculty, while in the future the experience can help shape efficient, quality health care systems across the nation.  

The diverse spectrum of disease and large multicultural population at LBJGH and related clinics offer huge opportunity for research, including translational research, ethics, public health, epidemiology, disease management, and pharmaceutical trials. Although this potential is just being tapped, further growth of the research environment requires the continued development of a committed LBJGH-based faculty and a larger collaboration with all of the UT Health Science Center components.  Another important component of clinical research development at LBJGH includes the database potential of the Epic clinical information system now being implemented throughout the HCHD with the physician leadership of Dr. John Riggs, an associate professor in the LBJGH Department of Obstetrics and Gynecology.  Finally, the Office of Harris County Programs is coordinating the UT faculty’s collaboration with the HCHD in the design and construction of more than $100 million of new construction or enlargement of facilities that will be completed early next decade.

5.       Which accomplishments of your office are you most proud?
1) The change in the AMS budget increased the number of trainees and faculty at LBJGH and its associated clinics while stabilizing the faculty with more realistic compensation levels.

2) UT-H HCHD professional fees now comprise 27 percent of all MSRDP charges and 11 percent of collections, and charges and collections have grown more than 15 percent and 31 percent, respectively, in the past year.

3) Services unique in the HCHD were added at LBJGH in the past year, including a new palliative care program and a non-teaching hospitalist service to improve quality and efficiency, and the geriatrics program was expanded.

4) An OR expansion project, championed by Dr. Tien Ko, chief of LBJGH surgery, and Dr. Peter Doyle, chief of anesthesia, in collaboration with HCHD staff, improved OR turnover times; decreased the outpatient waiting list for non-urgent procedures from months to days; converted inpatient to outpatient surgeries; and improved LBJGH surgical volumes by 18.2 percent in less than one year.

5)  By July 2009, LBJGH will have added 32 inpatient beds to its medical-surgical capacity in the past year while converting its four-bed rooms in the obstetrics floor to semiprivate rooms, an innovation that improved obstetrical volumes in the last six months.

6.       Other stories/opportunities/challenges you would like to share?
With a parking lot enlargement, construction of a $50 million, 36,000 square-foot emergency center (EC) expansion started in March that will convert the LBJGH EC, already the busiest Level III trauma center in the state, into a state-of-the-art EC with four large trauma bays, 69 individual exam rooms, and a dedicated imaging center with CT. These  improvements  will allow the growth of the emergency medicine residency by 18 positions over the next few years. When the new EC is finished, it will be longer than a football field.

A major challenge for LBJGH is bed capacity.  According to consultants engaged by the HCHD, the medical surgical occupancy at LBJGH is 96 percent despite its length of stay that is better than many American hospitals according to federal benchmarks. So the development of the new ambulatory surgery and outpatient building will allow the addition of much needed inpatient capacity by 2013.

Of special note is the fact that two members of our staff, Alma Rosa Leal and Jeanette Quintanilla, have served in the Chief of Staff Office since the inception of UT’s presence at LBJGH on July 1, 1990.  Their long-term service lends a degree of continuity and reliability to the office that is appreciated by those who rotate through the facility.  

There is terrific work going on at the Harris County Hospital District, and I thank Dr. Brown for his leadership.

Have a great weekend,

Giuseppe
 

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