Cleveland's University Hospitals is wrapping up the biggest project in its history, a $1.2 billion expansion that is sprouting new medical facilities around Northeast Ohio and linking them with advanced technology.
CLEVELAND, Ohio -- University Hospitals is wrapping up the biggest project in its history, a $1.2 billion expansion that is sprouting new medical facilities around Northeast Ohio and linking them with advanced technology.
In the face of an economic downturn that rattled even the relatively stable health-care industry, UH pressed ahead with the five-year project, called Vision 2010. By the middle of next year, the regional health-care network will have finished remaking its main Cleveland campus, opened a new suburban hospital and outpatient facilities, and begun introducing systemwide electronic medical records.
The expansion means more choices and services for patients, and more effective ways of managing their health information. For the region, it has provided a much-needed economic shot in the arm, creating thousands of jobs. And it positions UH to better compete with its University Circle neighbor, the Cleveland Clinic.
"We're not looking to cast a wide net simply to create a larger footprint," said Thomas Zenty, chief executive officer of the nonprofit system since 2003. "We follow the needs of our patients, and that's what we focus on."
The $298 million UH Ahuja Medical Center in Beachwood could accept its first patients in early 2011. A cancer hospital is slated to open in May on UH's main campus. Several new suburban outpatient facilities already are operating, and a much-larger emergency department in Cleveland could be finished in the spring. All told, the new construction portion of Vision 2010 is costing more than $700 million.
Expansion followed major turnaround
A decade ago, UH could not have dreamed of a billion-dollar expansion. The system was mired in nearly a decade of operating losses. Ratings agencies docked its bonds. Executives struggled to meet budgets and performance targets. Some physicians were leaving, and new doctors were heading to growing hospitals like the Clinic.
Before UH could transform, it had to recover.
In 2003, the system began trying to turn things around. Executives renegotiated managed-care contracts, reviewed agreements with suppliers, unloaded an insurance subsidiary, sold a psychiatric facility in Lake County and closed the money-losing St. Michael Hospital on Broadway in Cleveland.
By early 2006, the system's financial health and bond ratings had improved. Zenty unveiled a strategy to remake the main campus, expand in growing suburbs and add to services at some outpatient facilities. UH Case Medical Center, in University Circle, would see the greatest changes: a new neonatal intensive care unit at the high-profile Rainbow Babies & Children's Hospital in addition to the new emergency department and the comprehensive, freestanding cancer center.
Demand from East Side patients, and a $30 million donation to Vision 2010 from entrepreneur and UH board President Monte Ahuja and his family, drove plans for the Ahuja hospital in Beachwood. The first phase of the project includes 144 beds and a medical office building, but the 53-acre site at Richmond and Harvard roads could accommodate two more hospital buildings, 450 additional beds and more offices.
Years of restructuring made that vision possible. The painful pre-recession purging helped prepare UH for the downturn, when some health systems delayed building projects, deferred equipment purchases, pared budgets and eliminated jobs. Data from McGraw-Hill Construction shows that the value of new health-care construction projects fell to $20.1 billion last year, from a peak of $29.8 billion in 2008.
"A lot of hospitals were nixing their capital plans and cutting back substantially, and we just kept proceeding," said Bradley Bond, UH's vice president of treasury.
UH did delay some small projects last year, shifting spending into 2010. And several major developments are opening later than originally planned. But the system largely pushed on, funding its makeover with bond proceeds, operating revenues, gifts and grants.
At peak employment, Vision 2010 supported more than 5,200 construction jobs, many involving local, minority and small-business contractors. A year after the projects are finished, they will support an estimated 1,200 new nonphysician jobs.
"People have thought that health care is recession-proof, but hospitals are not," said Todd Nelson, technical director for senior financial executives at the Healthcare Financial Management Association. "From a bond-rating and capital-access perspective, there still is a lot of uncertainty out there. The strongest hospitals in the industry are still able to get a good bond rating and still have access to capital."
New medical center offers patient comfort
Even during construction, the UH Ahuja Medical Center feels more like a hotel than a hospital. The expansive lobby is filled with natural light and lined with spaces for artwork. Services like trash collection and deliveries are tucked out of sight. There are fitness areas, places for families to gather, and spacious rooms. The building was designed with input from patients, families and community members, and with cues taken from hospitality giants, including Ritz-Carlton Hotels & Resorts.
Watch this video about the UH Ahuja Medical Center
The priciest project in Vision 2010, Ahuja represents several of UH's priorities in a changing health care environment: Go where the customers are, consider Northeast Ohio's aging population and provide a consistent experience designed to move patients and providers through environments crafted specifically for them.
Like Ahuja, which is visible from Interstate 271, most of the Vision 2010 facilities are a short hop from a freeway exit. They fill holes in UH's eight-county service area, where the 65-and-older population is likely to grow 11 percent from 2009 to 2015, according to data from Thomson Reuters. With features including private rooms, green spaces, easier navigation and less clutter, even the buildings put the focus on the patient.
On UH's main campus, the 60,000-square-foot Center for Emergency Medicine will replace a 22,000-square-foot facility built in the late 1970s. Today, the halls of the second-busiest emergency room in Northeast Ohio teem with gurneys and waiting patients. In the new building, patient rooms will be large enough to accommodate families. Treatment areas for children and adults will be separate. And doctors will be able to isolate and decontaminate patients in the event of a bioterrorism attack.
Lab services and equipment are being built into the emergency room, eliminating the need to cart patients up and down the hall. That should make for quicker diagnoses and swifter treatments, enabling UH to cut wait times, said Dr. Fred Rothstein, president of UH Case Medical Center. "Walking into the physical space is going to be shocking to people who are living in sort of a cramped space in our emergency department today," he said.
A new parking garage will make it easier for patients and their families to get to the emergency room and the cancer hospital, a swoop-sided building that bellies up to Euclid Avenue.
The cancer hospital, which consolidates services from seven scattered locations on the main campus, will have 120 beds and room for 30 more. It will feature dedicated floors for specific services or conditions, equipment designed to limit the invasiveness and extent of surgery, exercise rooms, an adjacent breast center and a healing garden next door. Like Ahuja and the new neonatal intensive care unit, the cancer hospital also includes areas where patients' families can stay overnight.
"When you pull up to the front of the campus in the spring of 2011, you're going to see a completely different front door to University Hospitals," Rothstein said.
Digital records to help connect dots
The UH network is built like a pyramid. At the base are primary care physicians who offer services in small offices. Above them sit the suburban health centers. The next level is community hospitals, in locations such as Bedford and Geneva. The main campus, with clinical trials, research and the most specific and expensive care, perches on top.
Each layer is being tied to the others by what might be the most important, but least visible, component of Vision 2010.
Electronic medical records eventually will connect all the UH facilities, from the tiniest physician office to the teaching-and-research hub of UH Case Medical Center. The Vision 2010 plan set aside more than $100 million for a system that creates a single electronic chart for every patient. Such systems are not new in Cleveland, where the Cleveland Clinic and MetroHealth have been using electronic records for several years.
UH's system is being rolled out first at its central campus and hospitals. Starting early next year, the system will be extended to outpatient facilities and physician offices. Having a single, digital chart makes it easier for providers to assess a patient's condition, to prevent duplicate testing or dosing, to avoid allergy problems and to test for medical conditions. For patients, an electronic portal eventually could provide access to lab results, appointment schedules and online communication with doctors.
Before Vision 2010, the main campus was using a medical records program developed in the early 1990s. One community health center had its own program, while others relied on paper records.
"We've truly become a health system where clinicians at all facilities talk to each other and share best practices," said Lynne King, a division information officer. "In the old days, we were a loose federation of states. Now we're working together as a group."
New chart system helps prepare for reform
Moving to a one-patient, one-chart system makes UH more prepared for health care reform, the biggest challenge facing the industry. Zenty said it's too early to know what changes health reform will bring, though hospitals and health systems already are worried about how they can provide quality services at lower prices.
Health reform is affecting UH's next strategic plan, and the system's leadership has narrowed its focus from five years to three. The new plan might be available early next year, and it is likely to focus on taking advantage of what UH has now, rather than building more.
"We're convinced that as long as we stay true to our mission, invest wisely, don't overbuild, we'll be prepared for health care reform, whatever it looks like," Zenty said.
During the next few years, executives will focus on renovating existing facilities, including spending $50 million to update St. John Medical Center in Westlake, which UH started managing this year through a restructured joint venture with the Sisters of Charity Health System. Plus, all UH hospitals will get private rooms.
The system will be spending less of its own money on high-profile projects. But UH hopes to be the spark for other spending, through deals like its recent $38.4 million partnership with medical-imaging equipment maker Philips Healthcare, which will open a global research and development center next year at the new cancer hospital. UH executives also hope to use their purchasing power, about $800 million a year spent on products and services, to persuade suppliers to move into or expand in the city of Cleveland.
Pumping that kind of money into health care, sciences and technology will pay off long term for Northeast Ohio, said Monte Ahuja, the UH board chairman.
"There's a lot of other industry we have, and thank goodness," he said. ". . . . But I think we do need a major leader going forward, and that's going to be health care. We have a great responsibility and great expectations of being a key component of this leading movement."