UF&Shands Jacksonville: A Story of Success and Innovation (Part 1)

UF&Shands Jacksonville is one of the best-kept secrets in Jacksonville.

But it’s time we share its story of success and innovation, especially in view of the appointment last week of an energized Shands Jacksonville Board under revised governance, and in light of our plans for the future.

The strength of an academic health center lies in the integration of its academic core and its health system. For us, this is the working relationship between the University of Florida Health Science Center and Shands HealthCare. We communicate this close collaboration under single leadership as UF&Shands, the University of Florida Academic Health Center. This is what Forward Together is all about.

UF&Shands on the main UF campus in Gainesville is a large academic health center. But did you know that, among all state-supported universities in Florida, UF&Shands-Jacksonville is the only other academic health center that includes a hospital under university governance? While there are now medical schools at FSU, USF, UCF, FIU and FAU, none of these have hospitals under their governance. Therefore, they are limited in the extent to which they can integrate all aspects of patient care with education and research.

This is exactly what we do at UF&Shands-Jacksonville. Located on the same campus under one roof, the regional dean of the UF HSC Jacksonville campus, Robert Nuss, MD, works with the Shands Jacksonville CEO, Jim Burkhart, MBA, to advance patient care and academic success on a daily basis. As Senior Vice President for Health Affairs at UF, and Board Chair of Shands Jacksonville, on a weekly basis I meet with the dean and hospital CEO, and with the Shands Jacksonville CFO, Mike Gleason, to chart strategy and resolve ongoing issues. These weekly meetings are supplemented by daily phone calls as needed.

I have been extremely impressed with the seamless partnership and sense of shared commitment embodied by the leadership of UF&Shands-Jacksonville. The success of this partnership is clearly evident in the size and scope of the institution that they and their Board have created:

• a budget of about $900 million (2/3 hospital and 1/3 medical school);
• 370 full-time UF faculty who live and work in Jacksonville, in the colleges of Medicine, Pharmacy and Nursing;
• 320 residents and fellows;
• 5,000 staff employees (2/3 hospital and 1/3 medical school);
• 200 pharmacy students, 75 nursing students and 60 medical students;
• over 600,000 outpatient visits and more than 34,000 inpatient admissions annually;
• the internationally recognized UF Proton Therapy Institute, one of only seven nationally, which attracts patients from around the region and around the world;
• $125 million invested by UF in development of the Proton Therapy Institute;
• $200 million capital investment over the past decade in improving the patient-care environment; and
• external research grants totaling $18 million in the last fiscal year.

Some of these points deserve further comment. In this week's installment, I will amplify on education and patient care. Part 2 next week will be devoted to research, community initiatives, economic development and future plans.

Education

Educating the health professionals of tomorrow is a key mission of UF&Shands Jacksonville, one that is accomplished through educational programs for residents and fellows, medical students, pharmacy students and nursing students.

A successful graduate medical education (GME) program — i.e., the training of medical residents and fellows — is directly linked to the retention of physicians as practitioners in the community. GME comes under the auspices of the University of Florida, with the UF Health Science Center - Jacksonville having direct operational responsibility. This dedication to GME has resulted in significant program growth in the Jacksonville community over the past 10 years. UF has increased the number of accredited residency and fellowship programs at Shands Jacksonville from 19 to 27 between 2002 and 2010. In addition, three new UF GME programs (anesthesiology, psychiatry, pediatric surgery) are on the immediate horizon in Jacksonville. Overall, UF GME programs support 320 residents and fellows at UF&Shands Jacksonville. As such, the size and scope of GME on the UF&Shands Jacksonville campus ranks third in Florida, behind only its sister campus in Gainesville and the University of Miami/Jackson Memorial Hospital in Miami.

In 2010, 34 percent of UF Jacksonville graduating residents and fellows remained in Northeast Florida and 54 percent remained in Florida. Because resident and fellow education is crucial to the local economy and welfare of the area’s population, UF&Shands-Jacksonville is dedicated to working with the community to increase residency positions on the Jacksonville campus within existing programs as well as by adding new programs that may be needed.

The Jacksonville campus is an integral part of the medical student education program of the UF College of Medicine. UF medical students spend, on average, approximately 25 percent of their third year in required clerkships in Jacksonville. Fourth-year students from UF and other medical schools choose UF&Shands-Jacksonville for elective rotations as well. In 2010, third- and fourth-year students completed 3,058 student weeks in Jacksonville. Students and department chairs consistently agree that the medical student learning experience is greatly enhanced by the complementary experiences provided by both the Gainesville and Jacksonville campuses.

In addition to residents, fellows and medical students, there are 200 UF College of Pharmacy students and 75 UF College of Nursing students on campus, providing a ready source of health professionals in these disciplines for the Jacksonville region. Other than the UF&Shands campus in Gainesville, there is no other organization in Florida that provides this level of health professional education in size and scope.

Patient Care

In fiscal year 2010, there were 34,000 admissions to Shands Jacksonville and 607,000 visits to UF College of Medicine faculty in Jacksonville. UF faculty practice at 37 off-site clinical care locations throughout the region. The latest addition is the Emerson outpatient campus, which houses a multispecialty practice, advanced imaging, rehabilitation services and a surgery center.

Over the past 10 years, UF&Shands Jacksonville made substantial investments in primary care throughout the region. Primary care centers are now established in many areas of the Jacksonville community (24 offices with 83 providers). In addition, special emphasis was given to creating alternatives to the emergency department for low-acuity patients. Helping patients to receive care in the most appropriate setting is not only economically beneficial, it is also better for the patient. This effort resulted in the development of six targeted primary care sites and medical disparity clinics located in significantly underserved areas near the downtown Jacksonville campus. The growth in primary care visits has been associated, simultaneously, with a reduction in low-acuity ED visits from the area immediately surrounding the Shands Jacksonville emergency department.

In July 2010, six of these primary care sites were designated by the National Committee for Quality Assurance (NCQA) as Medical Homes. The NCQA describes the patient‐centered Medical Home as a model for care provided by physician practices that seek to strengthen the physician‐patient relationship. These practices replace episodic care based on illnesses and patient complaints with coordinated care and a long‐term healing relationship. This is the only primary care program in the region to be recognized by NCQA and the first academic program in the Southeast to achieve certification.

Development of dedicated inpatient units at Shands Jacksonville for specific UF services has enabled us to provide specialized resources for the most complex patients. These units include a unique cardiovascular unit where all inpatient, outpatient and professional services are united in a single location. A dedicated neurological intensive care unit was one of the first of its kind in the region. The transformation of the Shands Jacksonville Pavilion into a home for continuity-based programs such as transitional care, hospice, mental health and infusion services has helped both staff and faculty to provide the best possible experience for the patients they serve.

A new 120,000-square-foot Veterans Affairs (VA) Clinic will soon be developed on land adjacent to the downtown Jacksonville campus. The University of Florida and Shands Jacksonville have a long history of partnering with the VA. This collaboration will be further enhanced by the development of this new site.

Additionally, new programs and systems will enhance both safety and efficiency in all areas of patient care. Long before the national call for electronic health records, the UF College of MedicineJacksonville faculty practice led the region with the first major installation of a fully automated medical record. The Allscripts system has been operational for over nine years in Jacksonville and is in place at 58 UF clinical locations, where it is used by more than 500 UF providers. Across Jacksonville and Gainesville, UF&Shands is now implementing the next generation of electronic health records. The EPIC system will encompass both the faculty practice and hospital environment and will allow the organization to have a fully integrated platform to improve patient care.

UF&Shands-Jacksonville continues as the area’s major safety-net provider. In this role, a large volume of services are provided with limited economic support from local, state and federal sources. Over the past five fiscal years (FY05-FY09), Shands Jacksonville alone has provided $172 million in services on a cost basis in excess of funding received for these patients. Since 2002, the indigent care funding provided by the city of Jacksonville to Shands Jacksonville has been constant at $23.7 million per year. Since that time, the cost of caring for the underserved has increased significantly, to the point where the current model is not sustainable. In 2009, for example, the cost of providing such care was $67 million, resulting in $43 million in uncompensated care net of the city’s contribution.

I hope this update has opened your eyes to aspects of UF&Shands-Jacksonville that make us all proud. Next week’s installment will focus on research, community initiatives, economic development, and plans for the future.

Forward Together,

David S. Guzick, MD, PhD Senior Vice President, Health Affairs President, UF&Shands Health System