University of Iowa Hospitals and Clinics poised for second try at North Liberty facility - The Gazette

Cars travel east on Forevergreen Road, which is the border between North Liberty and Coralville, in 2015. (Liz Martin/The Gazette)

IOWA CITY — The University of Iowa Hospitals and Clinics’ second try to obtain a state certificate it needs to build a new $230 million facility off Interstate 380 is getting pushback just as the five-member State Health Facilities Council prepares to reconsider the project this week.

“If approved, this would be the most expensive hospital in the state’s history,” according to a media advisory MercyOne distributed last week. “UIHC is again asking for approval to build an expensive, taxpayer-funded hospital which would duplicate services in the region and unnecessarily compete with community hospitals.”

The state council in February narrowly rejected UIHC’s first application — voting 3-2 to deny permission to build the 300,000-square-foot facility at the corner of Highway 965 and Forevergreen Road. Among the councilors who voted “no” was Carol Earnhardt, who resigned unexpectedly in May.

Gov. Kim Reynolds in July appointed Kelly Blackford — a Marion Republican — to fill the vacancy. The governor’s office hasn’t answered repeated questions from The Gazette about Blackford’s appointment — including if she applied, whether anyone else applied and how she “demonstrated by prior activities an informed concern for the planning and delivery of health services,” as Iowa Code requires.

Opposition

In response to UIHC’s revised and more elaborate application to build in North Liberty and modernize its main campus — allowing it to staff up to 74 additional beds in Iowa City and 48 in North Liberty — the state received more than 80 letters of opposition and nearly 70 letters of support.

For the first application, the council received 53 letters of opposition and 27 of support. And discussion of the project — before the final vote — stretched on for seven hours.

A majority of the new application’s letters in opposition came from providers or affiliates of Mercy Iowa City; MercyOne, a system of hospitals that until recently included Mercy Iowa City and temporarily remains its managing partner; and UnityPoint Health.

“More than 80 health care facilities and providers once again have submitted letters of opposition to the State Health Facilities Council to communicate the significant problems associated with the project,” according to MercyOne, which cited among those problems “unnecessary competition with adequate hospitals and providers for staff and patients in the immediate vicinity, including 12 hospitals and surgery centers in the Cedar Rapids-Iowa City corridor.”

But UIHC in its application and response to state questions went to great lengths to explain how its expansion and modernization would not compete with community hospitals and instead in answer to a rising demand for complex care of the state’s sickest patients — who often are transferred from community providers unable to treat them.

“UIHC is anticipating approximately 5,000 additional inpatient and outpatient surgical cases within the first year of project completion,” UIHC officials told state council members, in response to their questions on its second application.

“This projection is based on patients who: a.) currently have to seek care out of state; b.) are unable to be transferred to UIHC due to current lack of capacity; or c.) could benefit from the level loading of operating rooms between Forevergreen Road and 200 Hawkins Drive to improve operational efficiency and improve safety.”

MercyOne in its letters and news release accused UIHC of trying to further develop its primary and secondary care services, “instead of focusing on tertiary and quaternary care as is the traditional role of an academic medical center like UIHC.”

“This is evidenced by their proposal and also by examining aggressive advertising campaigns promoting primary care services,” according to MercyOne.

But UIHC officials said the opposite in their application and answers to the state.

“It was not ever UIHC's intent to propose to construct, operate or duplicate community hospital services already offered by existing community hospitals,” officials wrote. “UIHC appreciates the opportunity to clarify that what UIHC is requesting is a modernization of its existing statewide tertiary institutional health facility, not to create or add additional community hospital bed capacity.”

Complex care comes in a variety of forms and necessitates both inpatient and outpatient services, according to UIHC.

“These patients are referred to UIHC by community providers, or seek UIHC care directly, because their surgeries are not appropriate for, and cannot be done safely in, a community ambulatory setting due to a variety of reasons ranging from high-risk co-morbidities to need for access to multi-specialty coordination and intervention,” officials said.

‘Urgency of the need’

In a letter of support for the project, Iowa Assistant Attorney General Samuel P. Langholz addressed the opposing perspectives directly.

“The application and supplemental responses detail the need for new capacity for tertiary care, how this proposal will meet that need and why none of the other alternatives is less costly or practicable,” Langholz wrote. “Yet many of the affected parties who oppose the application contend essentially that the council shouldn’t believe UIHC.

“These opponents — the vast majority of whom are affiliated with Mercy Iowa City or the MercyOne health system that manages Mercy Iowa City — believe that UIHC’s proposal actually seeks to expand UIHC’s primary and secondary care capacity in direct competition with Mercy Iowa City,” he wrote. “But these views are mistaken.”

UIHC officials told The Gazette and the state they have and continue to discussed community collaboration. But an evaluation found modernization and sharing arrangements alone aren’t efficient nor practical to meet their growing patient needs.

“Patients will — and already are — experiencing serious problems obtaining the tertiary care that can be provided under this proposal,” Langholz wrote, addressing critics’ concerns the second UIHC application came too quickly and without serious redrafting or reconsideration.

“The quick timing reflects not haste — but the urgency of the need for greater capacity to serve Iowans,” according to Langholz. “Every month this project is delayed results in care delayed, moved out of state or never provided.”

Despite the steep project price tag, UIHC officials — in response to state questions — said the $230 million would cover only the North Liberty facility and none of the main campus modernization.

“UIHC does not yet have costs for planned modernization at 200 Hawkins Drive,” officials said. “The ability to move forward with those modernizations is contingent on the State Health Facilities Council's approval of UIHC's CON application and would not be subject to CON review.”

Main campus renovations would, however, be subject to Board of Regents approval.

Suresh Gunasekaran, University of Iowa Hospitals and Clinics

And although modernization of main campus beds is contingent on realization of the North Liberty proposal, UIHC CEO Suresh Gunasekaran told The Gazette he expects tertiary care needs will persist and expand regardless as the coronavirus pandemic extends its reach across Iowa.

“COVID, and many such diseases, affect patients that already have preexisting conditions, that already have serious health care conditions, and they're more vulnerable to these kinds of diseases,” Gunasekaran said. “It's in those kinds of moments that you want to make sure that the University of Iowa Health Care has the opportunity to take care of those patients.”

UIHC of late has taken more COVID patients needing skilled and complex care, and that is an example — he said — of how on most days the health care providers across Iowa work in tandem.

“It really is a partnership, and what's lost in this discussion is that every single facility in the state of Iowa works with us, and we continue to work with them, and each of us have our own mission,” he said. “UIHC cannot be successful if community hospitals are not successful. Community hospitals, very conveniently, take care of care in the local community, do a good job.

“And when they do that, then that allows us to focus on those more complex conditions, and allows us to return those patients back to those communities. So this is really, honestly a partnership. And except for the week of the CON hearing, we really all do get along.”

Vanessa Miller covers higher education for The Gazette.

Comments: (319) 339-3158; vanessa.miller@thegazette.com

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