Members of the Board of Trustees are expected to give Medical Center officials the green light this weekend to move forward with plans to construct three new buildings and renovate existing facilities.
The expansions, which will cost the University at least $146 million during the next five years, are designed to prepare the Medical Center for the 21st Century's managed-care marketplace.
"The marketplace is telling us it's changing its definition of success, and we need to therefore modify our own internal thought process," said Steve Sloate, associate vice chancellor for Medical Center planning, communications and marketing.
Two of the three new buildings--the Ambulatory Surgical Center and the Ambulatory Care Clinic--focus on outpatient service, which will reduce hospitalization time and its related costs. The third building, the Children's Health Center, will consolidate pediatric specialty clinics and inpatient pediatric services (see graphic, page 4).
In addition, some of the children's center and ambulatory clinic operations will be handled in the Hospital's North and South areas, respectively. Because the South wing's mechanical infrastructure dates back to the 1930s, renovations on the first and second floors will "peel [it] back to the skin," Sloate said.
If the board gives its approval, Medical Center officials will then file a certificate of need with the state asking for permission to build the ambulatory center (see related story, page 4). Officials said they plan to file certificates of need for the other two buildings later this fall.
This weekend's presentation to the board brings to fruition close to three years of reassessment of the Medical Center's facilities and how they compare with market needs and the requirements of the Medical Center's programs.
"[The development of these facilities] was a convergence of two forces: ...lengthy internal conversation about looking at [our] inventory of teaching, research and clinical programs, and the shifting sands of the marketplace that were changing the definition of what consumer groups wanted from us," Sloate said.
Having studied the needs of individuals, families, insurers and government, Sloate's team found that these consumer groups wanted increased access to high quality care and greater cost-effectiveness. Since then, the University has distributed its medical services more widely by becoming associated with more community clinics; it also has contained consumer costs by becoming a member of many managed-care networks.
Because the new facilities will offer high quality care but limit costs through efficient design, they may attract more insurers and thus increase the Hospital's competitiveness with other managed-care facilities.
Sloate said that due to advanced planning, he expects the Medical Center to use a very limited amount of debt financing for the projects. Anticipating the emergence of managed care, the Medical Center's 1993 long-range plan proposed investing $195 million in new specialty and primary-care clinic facilities, a new parking structure and additional inpatient facilities. To become more cost efficient, however, the Medical Center trimmed back these expansion plans this spring. The ambulatory clinic suffered the largest cutback, from a seven-story, $131 million building to a two-story facility costing less than $70 million.
The ambulatory clinic, which is scheduled for initial occupancy in December 1997, will consolidate all of the Hospital's specialty clinics in one contiguous space, with adjoining areas in Hospital South, said Dr. Rex McCallum, assistant professor of rheumatology and immunology. The new layout will be more "patient-friendly" and will get rid of "the Byzantine quality of Duke South in its current form."
To this end, the users of the facilities will be involved in the architectural design of the buildings. "The people who are actually going to live in the space are going to be interacting very heavily with the people who are designing the space to ensure that the compatibility is there," Sloate said.
How the new, cost-effective facilities will affect the size of the workforce is unclear. "I can't tell you at this moment whether that means there will be more people or fewer people involved in the care and treatment of the patients that come through these facilities," Sloate said. "I can tell you that we are projecting a modest amount of growth in volume in these facilities."
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