Medical school, new hospital move forward

Seton must get its parent company, Ascension Health, to sign off on the new teaching hospital, which will be the largest project in Ascension's history. Seton officials expect to open the Level I trauma center by early 2017.

Because of voters' approval of Proposition 1 in November, Central Health hopes to maximize the amount of federal matching funds it can draw down from the 1115 Medicaid Waiver program.

The way health care is delivered is changing in Central Texas, according to local officials.

Programs are being designed so that patients will be treated in community clinics instead of more costly emergency rooms for chronic or preventable health issues.

"It seems like in Austin right now, the planning of a medical school, approvals from the federal government for a community care collaborative and the significant amount of money [being allocated] for outpatient wellness and prevention ... have created an extraordinary moment, and it's one we're taking advantage of in Central Texas," said David Evans, CEO of Austin Travis County Integral Care, which provides behavioral health and developmental disabilities services for area residents.

Hire the dean and staff

The University of Texas plans to select an inaugural dean for the Dell Medical School at UT by late summer to early fall 2013, UT spokesman Robert Cullick said.

The university has hired Witt/Kieffer, a search firm with experience hiring deans for medical and health science schools. Witt/Kieffer will cultivate a pool of candidates from applications and the firm's contacts in the education field, Cullick said.

"They are very familiar with the doctors and researchers who would find this a once-in-a-lifetime opportunity," he said.

The firm will later shrink the pool and give the top candidates' applications to the search committee.

The university formed an 18-member search committee in April. The committee includes educators, community leaders, health care professionals and students, according to a news release. It is chaired by Dr. Robert O. Messing, vice provost for biomedical sciences.

"The founding dean will be someone who can create a medical program that graduates doctors who are intellectually curious and inspired by their years studying with professors in many diverse disciplines," Messing said in a news release.

The new medical school will focus on research and community partnerships; the new dean will need to be able to lead in both disciplines, Provost Steven Leslie said.

UT hopes to have the new dean hired by the end of 2013, said Susan Cox, UT Southwestern Medical Center regional dean for Austin programs.

UT will look to staff the medical school once the new dean is in place.

In November, UT President Bill Powers said the school would recruit current teachers and hire about 35 new faculty members.

Cullick said there is no up-to-date estimate for transfers or new hires. One reason it is difficult to predict a future headcount is because a staffer may split his or her time between a current job and the new medical school, he added.

"We are looking carefully at the incredible strength on campus," he said. "We have people working in the engineering department, the McCombs School of Business, the information department, nursing, pharmacy and social work. Some of those folks want to participate in the new medical school."

Accredit and build the new school

The Dell Medical School at UT will need to become accredited by three groups: the Texas Higher Education Coordinating Board, the Liaison Committee on Medical Education and the Southern Association of Colleges and Schools.

UT has applied to THECB in order to be able to grant a medical degree, said Susan Cox, UT Southwestern Medical Center regional dean for Austin programs.

The LCME application is a three- to four-year process.

"We have to give preliminary accreditation showing that we can teach the students in the first year of medical school, that we have the curriculum in place and that we can provide a four-year curriculum," Cox told the Central Health board of managers May 1.

UT will need to prepare a proposal for any new doctoral degree programs and submit the proposal to the coordinating board. It will need to describe the faculty, what the school plans to teach and how it plans to teach it, UT spokesman Robert Cullick said.

After that, UT will need to complete a site-based review and obtain approval.

UT already has a SACS accreditation, but SACS must be kept informed in case the new medical school affects the existing approved coursework and programs.

The UT board of regents approved a $334 million plan for the first phase of construction, which will include research, educational and administrative buildings, as well as a 515,000-square-foot medical office building and parking garage, according to UT.

UT has begun the search for an architect for the research and medical office buildings, Cullick said.

Construction and implementation of Phase 1 are expected to take two to three years, Provost Steven Leslie said.

At full capacity, the new school may train up to 100 students per graduating class, she said.

What's being said

William Eugene Powell, chairman, UT board of regents

"It isn't every day that a premier research facility gets a medical school. In fact, it has not happened in 35 years."

David Evans, CEO, Austin Travis County Integral Care

"[The 1115 Waiver] moves into coordinated care at the point of service. A doctor would be able to call up past mental health treatment records, receive real-time consultation and then look at coordinated treatment of things like long-term chronic conditions such as asthma, depression, diabetes or schizophrenia."

UT Chancellor Francisco Cigarroa

"It's going to be an extraordinary opportunity to educate generations of academic leaders and also have the synergy to develop the breakthrough discoveries that will help us solve some of the morbidity and mortality of diseases we still don't have answers to cure. That's within the realm of possibility for this school."

Greg Hartman, CEO, UMC Brackenridge

"Seton Healthcare is bringing together the research and minds of UT and combining them with Austin's creative class, [venture capitalists] and entrepreneurs. This is the beginning of a change in health care in this country, and this may be the first great hospital of that new era."

Replace University Medical Center Brackenridge

Seton Healthcare plans to open a new teaching hospital to replace University Medical Center Brackenridge in early 2017—a few months after the medical school opens in summer 2016, UMCB President/CEO Greg Hartman said.

There is no cost estimate for the new hospital because Seton has not yet officially selected a site or prepared designs, Hartman said. Seton is still working on what services the new hospital will provide, he added.

Seton has pledged up to $250 million to build the hospital. Hartman said Seton's parent company, Ascension Healthcare, is scheduled to approve funding June 11.

"This is the largest project Ascension has done within its system," he said. "The money will come from Seton's operating funds. We will also seek a significant amount of community philanthropy similar to when Dell Children's [Medical Center] opened."

Seton has already begun fundraising and will continue doing so for five years. So far, feedback has been positive.

"At our most recent luncheon fundraiser for UMCB, we had our largest crowd in our history," he said. "We were turning people away."

Hartman said Central Health plans to lease the land for the new hospital from UT.

The new teaching hospital will be an upgrade from the 1970s-era UMCB, he said. For example, UMCB has had to install hundreds of new electrical outlets and place computer servers in utility closets.

"When you have an intense use of a building such as a Level 1 trauma center, there are a lot of inefficiencies," he said. "In the new building, we will be more efficient and greener."

The hospital will have space for impromptu meetings, research projects and consultations with patients, as well as more procedural rooms and psychiatric beds.

Fast facts about UMCB

• Opened 1884 as City's County Hospital
• Oldest public hospital in Texas
• Renamed Brackenridge Hospital in 1929
• Renamed University Medical Center Brackenridge in 2008

Raise funds for the new campus

UT's initial estimate of how much money it would take to build and run the new medical school was $3 billion–$4 billion, UT spokesman Robert Cullick said.

In May, UT board of regents approved a $334 million plan to build the first phase of the medical school campus. The project would be financed through revenue bonds issued by UT, backed by funding from the UT system and the available university fund, which is part of the state's $19 billion endowment for UT and Texas A&M University schools.

It may cost more than $500 million a year to run the hospital and medical school, Cullick said.

"To put that in perspective, UT's annual operating budget is $3.4 billion, and what we spend to teach students is around $1.2 billion," he said.

To help fund for the new improvements, the UT board of regents has agreed to invest $25 million a year in the project, Cullick said.

UT is also planning a major fundraising campaign.

Cullick said donors could fund "places, people and programs," meaning naming rights for the school buildings, individual endowments for faculty positions and individual areas of research.

So far, The Michael and Susan Dell Foundation has pledged a $50 million grant over 10 years.

Seton Healthcare already spends $45 million per year funding a medical residency program at University Medical Center Brackenridge, UMCB President/CEO Greg Hartman said. It intends to expand that funding to help establish the medical school.

Travis County taxpayers agreed to support the school's creation when they approved Proposition 1.

Proposition 1 raised the property tax rate of the county hospital district, Central Health, by 5 cents per $100 of assessed value. The vote authorized Central Health to purchase services through the new hospital and draw down matching federal funds through the 1115 Medicaid Waiver.

Take advantage of a federal waiver

Travis County voters took three major actions by approving Proposition 1 on Nov. 6.

First, voters agreed to raise the property tax rate of its hospital district, Central Health, by 5 cents, from 7.8946 cents to 12.9 cents per $100 of valuation. That will send millions of dollars into the coffers of Central Health to help improve local health care.

Second, voters approved using some of that money to participate in a federal matching program as part of the 1115 Medicaid Waiver. The 1115 Medicaid Waiver is a five-year program intended to encourage new ways to improve local health care.

The new tax rate should generate an additional $54 million annually, which the federal government will match with $76 million for a total of $130 million for health care upgrades, according to Central Health spokeswoman Christie Garbe.

Third, voters offered support for the establishment of a new medical school in Austin.

The vote authorized Central Health to purchase health care services for qualified patients at the local clinics and Seton's new teaching hospital.

As part of its participation in the waiver program, Central Health is responsible for administrative tasks and communicating with the Texas Health and Human Services Commission on behalf of a six-county area called Region 7.

Central Health submitted a revised list of waiver-eligible projects to the state HHSC on March 11, Central Health Waiver Director Sarah Cook said.

Region 7 got presumptive approval for its projects—and the first round of reimbursements—when the state forwarded the plan to the federal government recently, she added.

"We are chomping at the bit to begin this work and bring these care models and programs to life," she said. "This will mean things like keeping clinics open later and expanding dental and behavioral health care in the community.

"Now is the time. We've been laying the groundwork for these projects. As soon as we hear back from the federal government, we can start."

Initial feedback from the Centers for Medicare and Medicaid Services was expected in mid-May, she said. Projects may need to be tweaked or amended to qualify. Final federal approval may arrive in fall 2013 or early 2014, she added.

Health care providers take a calculated risk in providing waiver-eligible services, Garbe said.

The provider submits a project with benchmarks and receives state and federal approval. Then the provider must pay upfront to perform that new service and wait for direct reimbursement after achieving results.