UF&Shands Jacksonville: A Story of Success and Innovation (Part 2)

Over the past decade, UF&Shands Jacksonville has completely turned itself around. In 2001, the hospital was operating at a loss and had little cash on hand. Thanks to substantial investment by Shands at UF, the city of Jacksonville and the University of Florida, and to excellent management by hospital and university leaders and the Shands Jacksonville Board, the picture steadily improved, year-by-year. Now, in 2011, the hospital is operating in the black with sufficient funds to invest in the academic mission of the faculty at the UF College of Medicine-Jacksonville and in the capital investments needed to support a higher level of patient-care with appropriate facilities and technologies. Moreover, the faculty practice plan has become, by far, the largest group practice in the region, providing a full range of health services to the broad community of Jacksonville, while accomplishing its safety net mission of delivering needed medical care to those with limited means.

As the fiscal status of UF&Shands Jacksonville improved, it became able to invest in its core missions to become a vibrant full-fledged academic health center. Last week, I reviewed the impressive progress that has been made in education and patient care. This week, I will summarize the fruits of our investments in community initiatives and research, and will also comment on economic development and the training of Jacksonville's future health care professionals. The newsletter closes with a look at future directions.

Community Initiatives

In 2006, the Florida Legislature tapped Duval and Broward counties to pilot a new way to finance and deliver care to those insured through the Medicaid program. Public and private insurers were invited to participate in the pilot program. In response, UF&Shands established a provider service network called First Coast Advantage (FCA) to coordinate health benefits for the Medicaid eligible population in Duval County. FCA has grown from 16,000 enrollees in its first year to approximately 46,000 members today. A study conducted by UF’s Department of Health Services Research reported in June 2009 that these pilot programs achieved significant savings during the first several years of operation. As health care reform evolves, this program may prove to be an important model for Florida and the nation.

UF&Shands Jacksonville operates more than 20 health education and outreach initiatives aimed at improving the quality of life in the region. Registered nurses, UF physicians, physician assistants, pharmacists and volunteers provide routine health screenings, education, disease counseling and case management. They also make referrals and link clients to other community service partners, regardless of insurance or ability to pay.

UF&Shands Jacksonville is committed to decreasing disparities in health care delivery across ethnic and economic lines. Current programs reflect the city’s major causes of morbidity and mortality. UF&Shands Jacksonville is especially vested in improving the health of residents living in the community surrounding the hospital, the most populated area of Jacksonville’s urban core.

The Jacksonville urban core has the largest number of minorities, lowest household income and level of education, and highest unemployment rate for the city. It also has the city’s highest mortality rate from heart disease, diabetes and HIV/AIDS, as well as the highest infant mortality rate. UF&Shands Jacksonville offers community-responsive programs for expectant parents and people with conditions such as diabetes, high cholesterol, high blood pressure, HIV/AIDS, sickle cell and other blood disorders. The success of these programs is evidenced by their longevity and community support. Some of these programs are listed here:

• Heal Thy People is a partnership between Shands and more than 54 local churches to promote wellness and improve access to health care through education, outreach and community activities.
• Ryan White Part A Program identifies and tracks people living with HIV/AIDS. The program provides education, screening, counseling and spiritual support for those living with the disease.
• C.B. McIntosh Pediatric Sickle Cell Program provides genetic counseling, medical management, education and emotional support to children living with sickle cell disease and their families.
• Shands Jacksonville Trauma Prevention Program encompasses seven initiatives aimed at reducing the number and severity of injuries in children.
• Little Miracles/Healthy Start reduce infant mortality by providing education, counseling and health care for expectant and new mothers and infants.
• Shands has formed a partnership with the Darnell Cookman High School’s medical magnet program, which includes student experience in the UF&Shands Simulation Center.
• Shands has a partnership with the Second Harvest Food Bank to provide healthy food to expectant mothers during their prenatal visits.

Research and Innovation

A key element of an academic health center is a passion to explore, discover and innovate. UF faculty members at the University of Florida Health Science Center–Jacksonville currently have more than 550 total Institutional Review Board-approved studies and protocols, of which 225 are externally funded, amounting to $18.5 million in the last fiscal year.

The UF Health Science Center-Jacksonville has recently added a 16,000-square-foot research laboratory building, including space dedicated to translational research, which is focused on bringing discoveries to patients as rapidly as possible. The Jacksonville campus also houses a clinical research unit to perform specialized inpatient studies and has designated resources for extensive outpatient studies.

In 2006, the University of Florida Proton Therapy Institute opened on the Jacksonville campus. A truly innovative addition to Jacksonville, UFPTI is one of only seven facilities in the United States equipped to treat cancer with protons. Hailed as the "next generation" of radiation treatment, proton therapy is gaining recognition in the medical and scientific community. Proton therapy greatly reduces the damage to surrounding tissue which is a significant improvement over traditional radiation therapy. Unlike other forms of therapy, it allows patients to continue their daily activities.

The initial investment to develop UFPTI was $125 million. Since the opening of UFPTI, more than 2,200 patients have received approximately 79,000 individual treatments. More than 70 percent of these patients come from more than 60 miles away. Patients from 49 states as well as a number of other countries have been treated here in Jacksonville. Proton patients typically stay in and around the city for their average six-week treatment. Currently, there are approximately 105 proton patients treated each day. UFPTI is among the top 10 proton therapy centers worldwide for number of patients treated.

UFPTI is a designated National Health Service (United Kingdom) proton therapy treatment center for pediatric and adult patients. The first patients under this agreement were treated here in December 2009. St. Jude Children’s Research Hospital and UFPTI began a proton therapy clinical trial in December 2009 for brain cancer patients younger than 3 years old. Approximately 98 percent of UFPTI patients are treated on one or more of 29 clinical research protocols.

Economic Development and Training Health Care Professionals

The benefit to a community of an academic health center extends beyond the provision of health care services to its citizens. Innovative approaches to new treatment methods bring patients to the community from outside the region. The scientific enterprise leads to jobs directly funded by research grants, and potentially to discoveries that can be licensed to existing companies or lead to the formation of start-up companies. And the training of medical and surgical residents and fellows, as well as nurses, pharmacists and other health professionals, provides a ready source of individuals ready to enter the local workplace in fields where shortages exist.

The community of Jacksonville already has such an academic health center — UF&Shands Jacksonville. A goal of this newsletter — and similar messaging to begin in the broad Jacksonville region — is to convey this very point and to suggest that additional investments in the educational programs and research of UF&Shands Jacksonville would yield excellent returns in terms of economic development. Examples of the benefits of such a strategy are as follows:

• The funding of new residency positions in areas of shortage such as primary care would — with a relatively short time lag — produce fully trained medical practitioners, about 40 percent of whom would remain in the Jacksonville region. This percentage could increase if the community provided loan forgiveness and/or other incentives. This investment would be much more efficient than, for example, funding a new medical school. The latter approach would be associated with a much larger lag in the production of fully-trained medical practitioners, would yield a much lower percentage of medical students remaining in Jacksonville for their residency (since the resident match for students is national in scope), and would be much more expensive.
• Investment in research facilities and investigators could build upon the existing scientific programs at UF&Shands Jacksonville and create a multiplier effect for economic development in the community. In general, to bring in $4 of external grant support in a successful reseach program, $1 needs to be added. Thus, an investment of $1 million annually should attract $4 million in external funding, adding a total of $5 million directly to the local economy, which then generates its own economic multiplier as it ripples through real estate, restaurants, supermarkets, banks, etc. However, to be successful, one needs an investigative foundation and scientific know-how. In this regard, we can be proud that the research program at UF&Shands Jacksonville, with $18.5 million in external funding annually, is already greater than the combined total of the four medical schools created in recent years by the Florida Legislature. Moreover, collaborative research utilizing the substantial scientific infrastructure at the Health Science Center in Gainesville, and the HSC's extensive number of investigators, will ensure success in the research investment.

We also intend to continue to invest to expand the scope of our innovative patient care programs. For example, given the success of the UFPTI in providing world-class cancer treatment, and in contributing new knowledge about the efficacy and safety of proton therapy, we are considering the introduction of additional treatment modalities, based on clinical research data from our own faculty and using technologies only available in a couple of locations worldwide. This will not only serve as a beacon for cutting-edge cancer treatment in Jacksonville, but will continue to promote economic developemt by adding jobs and attracting patients and their families for multiple stays in Jacksonville.

Future Directions

As UF&Shands Jacksonville looks to the future, commitment to the patients served on our Eighth Street campus must be maintained, but regional expansion to meet future growth is also imperative. Property purchased near Jacksonville International Airport is poised for development of UF faculty practice sites, with permitting and other pre-construction activity moving forward.

Expansion will also include new space for education and research. Funding for facilities and faculty recruitment to support this growth will require partnering with foundations, philanthropy and support from the city and state.

Further expansion of the Emerson Street outpatient campus is anticipated. The third building on the site includes 10,000 square feet of shelled space intended to house additional UF faculty-led clinical services. In addition, steady growth of the UF primary care network to meet local demand and to enhance access to the overall UF&Shands Jacksonville network is expected. To enhance the number of medical residents and fellows who train on the Jacksonville campus, UF&Shands Jacksonville should partner with granting and philanthropic organizations. The establishment of a fund dedicated to this purpose will enable new physicians to practice in the Jacksonville community. Concurrently, a loan forgiveness fund dedicated to keeping medical residents in the community after their residencies would enhance the attractiveness of Jacksonville to new residency graduates.

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. 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 hospital care. Clearly, the mission to care for the medically underserved patients in Jacksonville requires a reliable source of funding. UF&Shands Jacksonville is committed to supporting the region’s safety-net mission and is prepared to work with local leaders to secure stable funding for this vulnerable population.

Concluding Comments

It is clear that UF&Shands Jacksonville has made tremendous progress in its clinical, educational, research and community missions and now functions as a mature academic health center. We now turn a new chapter in this story of success and innovation, ushered in by a new Shands-Jacksonville Board — which I have the privilege to chair — and a new governance structure under the umbrella of the University of Florida. Future growth in education, research and economic development will be linked to three complementary strategies: investments by the University of Florida and by Shands Jacksonville in program expansion based on internally generated revenue streams, philanthropic support, and partnership with governmental and business leaders in support of economic development and health professional training. This is an exciting time for UF&Shands Jacksonville; the best is yet to come.

Forward Together,

David S. Guzick, M.D., Ph.D. Senior Vice President, Health Affairs President, UF&Shands Health System