State explains about-face on University of Iowa hospital in North Liberty

NORTH LIBERTY — In explaining its reversal of an earlier decision to deny University of Iowa Health Care permission to build in North Liberty, Iowa’s five-member State Health Facilities Council highlighted the role semantics played in its about-face.

In submitting a request for a do-over, UIHC officials didn’t amend the project cost or size, but did change how they described the project. For the state council, that was a “significant” difference.

“The prior application proposed the establishment of a new institutional health facility which would have resulted in a new acute care hospital in this service area,” according to a recently-released justification of the council’s 4-1 approval in August. “This proposal does not result in the establishment of a new institutional health facility nor the addition of any licensed hospital beds.”

The original application, denied in February by the state, indicated “UIHC intended to establish a ‘general acute care hospital’ providing services similar to those offered at a community hospital or outpatient surgical facility,” according to the council decision. “This proposal instead aims to expand access to tertiary care and enhance the UIHC’s teaching and research missions.”

In its revised application, UIHC nixed the “hospital” description and instead characterized the project as a “modernization of UIHC’s existing institutional health facility.”

Nonetheless, after the approval was secured, officials reverted to describing the project as a new hospital despite the documents.

“This new hospital will help us fulfill our teaching mission, our research mission, and our educational mission for Iowans at large, and really for the whole Midwest,” UI President Barbara Wilson said during an Oct. 14 groundbreaking.

“High-quality care, top-notch medical training, expanded research opportunities, UIHC has established itself as a leader in each of these critical areas,” Gov. Kim Reynolds said during that event. “And I have no doubt that this hospital, when completed, will reinforce and strengthen that well-deserved reputation.”

Days after finally getting approval to build a $230 million, nearly 300,000-square-foot facility in North Liberty, UIHC revealed plans showing it intended to construct a more sprawling campus on its 60 acres at the corner of Forevergreen Road and Highway 965. The projects grew to involve 469,000 square feet of construction, bringing the total cost to $395 million.

Because UIHC didn’t require a state “certificate of need” for 169,000 square feet of academic, research and clinic buildings attached to the new facility, that piece wasn’t discussed in the application and wasn’t addressed by the council.

‘Limitations of collaboration’

In the decision, council members noted they also were swayed by work UIHC did between the two applications to answer questions about cheaper alternatives and potential collaboration with community providers — including the many who spoke or wrote in opposition to the UIHC expansion.

“The prior application failed to establish that UIHC had adequately considered alternatives to the project,” according to the council’s decision. “This application included independent assessments regarding alternatives and new information regarding the limitations of collaboration or other construction alternatives to meet existing needs.”

Although the first application did point out the role UIHC plays in treating the state’s sickest and most complex patients, it also reported up to 32 of its 36 inpatient beds would be dedicated to orthopedic-related inpatients and recovery.

“Orthopedic surgery would account for a significant portion of the initial service mix,” according to the original, rejected application. “Moving these high-volume, high-growth services to a new campus would not only decongest UIHC main campus but also provide a more efficient platform to accommodate growth.”

Community health care providers took issue with that, as orthopedics are key revenue generators for them.

In UIHC’s subsequent application, it pulled language about orthopedics and focused largely on the need to physically grow; expand teaching and research capabilities; and add capacity to keep Iowa’s sickest patients needing “tertiary care” from leaving the state to get it.

“Tertiary care is different than primary and secondary care in several respects,” according to the council’s decision. “Tertiary care requires more space and technology than community care; tertiary care requires dedicated teams with providers across many specialties.”

Asked if UIHC plans to move lucrative orthopedic beds from its cramped Iowa City main campus, officials said plans for the North Liberty campus “remain flexible as we continue to evaluate and determine which clinical specialties will be offered on the new campus based on patient demand.”

“Based on this patient demand, orthopedic subspecialties may be included at the new location.”

Since the UIHC approval, Steindler Orthopedic — based in Iowa City — has floated plans to build an ambulatory surgery center and orthopedic clinic in North Liberty near the UIHC project. Steindler also reported an unnamed hospital system has approached it about a potential partnership to erect an inpatient hospital on its land.

‘Need for tertiary care’

Between applications, the state council reported, UIHC asked a consultant to assess opportunities “to address the need for tertiary care through referral to existing community hospitals across the state.”

That analysis found 2 to 3 percent of UIHC inpatient days potentially could go to community hospitals instead, while the other 97 to 98 percent of patients aren’t appropriate transfers because they need more complex care; need clinical services unavailable elsewhere; have existing relationships with UIHC providers; or require behavioral health services unavailable elsewhere.

A lack of additional capacity, however, “causes UIHC to turn down approximately 2,200 to 2,400 requested transfers each year for patients whose referring providers have independently determined those patients need access to UIHC,” according to the decision. “The Iowa Hospital Association estimates that over 6,800 patients leave Iowa annually for complex care.”

In articulating a long-range plan in its second application, UIHC reported plans to address tertiary-care needs not just through the North Liberty expansion but by modernizing its existing campuses and continuing collaborative conversations with potential partners.

The council got 69 letters of support for the North Liberty project and 87 letters opposing it.

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