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U. of C. ties its promise on trauma service to expansion of hospital

Mitchell HospitalThe University of Chicago is using its commitment to bring adult trauma services to the South Side to win state approval of a significant expansion of the Hyde Park medical center.

University of Chicago Medicine says it would like to increase the size of its 617-bed hospital by 188 beds, a 30 percent increase. The new beds are needed to reduce overcrowding at the hospital and improve access to care for patients with complex conditions such as cancer and heart disease, said Sharon O'Keefe, president of the medical center.

The proposal is a new wrinkle after December's surprise announcement that the university would build a Level 1 adult trauma center on its Hyde Park campus, after years of resisting public pressure. The university ditched plans, unveiled just three months earlier, to open a trauma center at Holy Cross Hospital on the Southwest Side, in partnership with Sinai Health System.

In December, the university said trauma services would be integrated into a new, enlarged emergency department that would be built next to the core of its medical campus, the 10-story hospital that opened three years ago.

The university, it turns out, has more ambitious plans tied to trauma care than an expanded ER, which may explain why it abandoned the partnership with Sinai Health.

The medical center said all three parts of the $269 million project are tied together: trauma services, the enlarged ER and additional beds. Whether the university would make good on its promise to provide adult trauma services if the additional beds are not approved by the state health planning agency is unclear.

At least initially, the university is taking an all-or-nothing approach, according to its paperwork filed this week with the Illinois Health Facilities and Services Review Board, which oversees health care construction to coordinate planning of new services and control costs.

"This Project has three related and interdependent components, each of which is necessary for the success of the other two," the university wrote in the 571-page application.

By adding hospital beds to the trauma center plans, U. of C. Medicine has made the project more complicated to review, said Margie Schaps, executive director of the Health & Medicine Policy Research Group in Chicago.

"I know we need more health care services on the South Side," Schaps said. "But every time you add a layer of complexity, you're adding the potential for more questions."

South Side activists who had been campaigning for years for U. of C. to add trauma services were caught off guard by the university's expansion plans.

"There are a lot of questions that can't be answered," said activist Veronica Morris-Moore, referring to how the hospital expansion could affect the proposed trauma center.

She added: "We're not fighting for a commitment for a Level 1 trauma center; we're fighting for a Level 1 trauma center. Until that happens, we're going to continue to organize."

O'Keefe said she is confident the health planning board will approve the entire project because the needs of the South Side go beyond trauma services.

The medical center's inpatient admissions were up 9.7 percent in the fiscal year that ended June 30, according to Moody's Investors Service, a credit rating agency, continuing a trend that started in 2009.

U. of C. Medicine's increase in patient volume bucks a national trend toward less hospitalization and more treatment in doctors' offices and outpatient clinics. O'Keefe said several factors have contributed to the growth, including fewer hospitals on the South Side, the demand for complex care from an aging population and more people with insurance thanks to the Affordable Care Act, also known as Obamacare.

Proposed facilities

The hospital was so full last year that on 310 days, U. of C. had to turn patients away because of bed shortages, O'Keefe said. Bed shortages also affect the ER. In fiscal 2015, the emergency department had to divert ambulances to other hospitals 11 percent of the time, up from 6 percent in fiscal 2014, the medical center said in the application.

"As opposed to thinking about trauma, emergency and specialty care as separate components, we looked at how we can best respond to all of those needs," O'Keefe said. "I think the board will see the importance of our responding to all of those demands on the South Side."

U. of C. projects that visits to its adult ER will continue growing through 2021, in part because of the proposed addition of trauma services. About a quarter of ER patients are admitted to the hospital.

The medical center plans to increase the number of exam rooms in the ER from 36 to 41, which includes four trauma resuscitation bays. The ER currently is located in an older facility on the medical campus, called Mitchell Hospital. By moving it closer to the newer hospital, known as the Center for Care and Discovery, the medical center hopes to reduce ER wait times.

It would take two years to complete the ER and offer trauma services, if approved by the state board, U. of C. said in its application.

U. of C. also would like to increase the number of medical-surgical beds, from 338 to 506.It plans to add 20 intensive-care beds to grow the unit to 146 beds. In all, the medical center would have 805 beds, about the size it was in the late 1970s, U. of C. said.

As part of the project, Mitchell Hospital would be dedicated to cancer care, one of U. of C.'s top specialties.

The university acknowledged that it has financial reasons for wanting to add medical beds. The adult ER lost $32 million in fiscal 2015, and the medical center expects the losses to grow with the addition of trauma services. Despite the ER loss, the medical center reported operating income of $84.1 million in fiscal 2015. Operating revenues were $1.54 billion, up 6.6 percent from a year earlier.

U. of C. said it remains committed to "subsidizing" the cost of high-quality emergency care and trauma services.

"To ensure the sustainability of these services, UCMC must have bed capacity to accommodate the growing demand for specialty services in addition to the demand for emergency and trauma care," the medical center said in its regulatory submission.

The medical center plans to borrow $200 million to pay for the project, and the remaining funds would come from operations.

Chicago Tribune's Dahleen Glanton contributed.

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Note: An earlier version of the photo caption at the top of this story contained incorrect information about what would be located in the renovated Mitchell Hospital.

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