- By Ralph K.M. Haurwitz American-Statesman Staff
The operating rooms in the new hospital on the University of Texas campus are equipped with video cameras that let a physician halfway around the world, or medical students across the street, watch heart, brain and other surgeries as they unfold.
“It’s actually not a bad way to introduce students to surgery,” said Clay Johnston, dean of UT’s Dell Medical School, who has seen what happens sometimes when procedures are witnessed in the flesh, so to speak. “Not every student is standing at the end of their first surgery.”
The Dell Seton Medical Center at the University of Texas, which opens May 21, will serve many purposes, among them: primary teaching hospital for the medical school, part of the safety net for indigent patients, Level 1 trauma center serving 11 counties, and fertile research ground for an emerging medical and innovation district.
Bright, airy and state of the art, the $310 million hospital replaces the aging University Medical Center Brackenridge just across 15th Street. By any measure, Dell Seton stands as a major addition to the health care infrastructure of Central Texas.
And yet even as officials are celebrating the new hospital, they say it isn’t the primary focus of a growing effort to keep people out of hospitals, to transform care into a patient-centric approach that achieves better outcomes at lower cost and to foster what they call “a model healthy community.”
That mission is spelled out in a series of interlocking agreements involving the Seton Healthcare Family, the hospital’s owner and operator; Central Health, Travis County’s health care district charged with providing care for low-income and uninsured residents; and the university, which receives $35 million a year in Central Health property taxes for the medical school, thanks to a referendum approved by voters in 2012.
“What we’re trying to do is really focus on wellness,” said Maurie McInnis, UT’s executive vice president and provost.
That explains why Dell Seton has 211 patient beds, fewer than the 224 at UMC Brackenridge, the hospital it is replacing, even though the region is seeing steady growth in population. Officials are hedging their bets, though: The new hospital has capacity to add up to 135 beds.
“If you keep building beds, you’re incentivized to keep trying to figure out how to put butts in beds,” said Greg Hartman, Seton’s chief external and academic affairs officer. “We’re trying to figure out how to take advantage of this new technology, this new approach to things, and the medical school is a huge partner in that because that’s their whole goal, which is to transform the system.”
But for those patients who need to be hospitalized, whether they are indigent or covered by insurance, and for students, nurses, doctors and others who will work, learn and research at Dell Seton, it is “a beautiful hospital, very thoughtfully designed, with education in mind, innovation in mind, lots of technology,” Johnston said. “This is a hospital and a Level 1 trauma center that we can all be very proud of.”
New touches of hospitality
The hospital has many thoughtful touches. A sensor in each patient room will detect the identity tag of an entering caregiver and flash his or her name and role on a flat-screen monitor for the benefit of the patient and visiting friends or relatives. Public areas have a spacious feeling, with broad windows and outdoor tables along Waller Creek, as well as a dining room, complete with a pizza oven, open to the main hall.
Johnston likened the overall effect to a Courtyard by Marriott hotel. “It’s very carefully designed,” he said. “You feel good in the space, but it’s not the Four Seasons. And that’s exactly the way it should be.”
Other features of the new hospital include an oversized bay that can accommodate 15 emergency medical vehicles in the event of a mass casualty, trauma rooms convertible into operating rooms to avoid having to transfer patients, conference areas sprinkled around the building so that discussions about education and research can take place on-site, and “team stations,” formerly known as nurses’ stations, that are a model of efficiency, with views into patient rooms and designated locations for equipment — even the stapler — to cut down on unnecessary steps.
The opening of Dell Seton and the closing of UMC Brackenridge mark the end of an era: 133 years of public ownership of Brackenridge, which has existed under various names since its inception as the state’s first public hospital in 1884.
The change has prompted few objections in Austin, despite Seton’s status as a private health system under the auspices of the Roman Catholic Church. UT farms out activities barred by the church, such as birth control and certain reproductive services, as well as related training, to other health care providers, like St. David’s HealthCare, which has no religious ties. UT officials have said they do not know of another public medical school whose primary teaching hospital is Catholic.
Interviews with various officials and a review of the agreements involving Seton, UT and Central Health make it clear that the three parties are joined at the hip — and the ankle and the neck as well — in overlapping efforts to advance health care. For example, the new hospital sits on UT land that is leased to Central Health and subleased to Seton, which pays the university annual rent starting at $877,621 and rising each year based on the Consumer Price Index but by at least 1 percent. Central Health has the option to purchase the hospital if Seton fails to operate it as part of the safety-net system for low-income and uninsured people.
“We were trying to bring comfort and protection around the public nature of this even though it wasn’t being built with taxpayer dollars,” said Christie Garbe, Central Health’s vice president and chief strategy officer.
Seton, along with its parent, Ascension Health, put $260 million into the hospital and led a $50 million fundraising campaign anchored by a $25 million donation from the Michael & Susan Dell Foundation.
UT is obligated to provide some of the staffing for Dell Seton, the Dell Children’s Medical Center of Central Texas and a series of community clinics. Seton is required to help underwrite positions for UT’s residents, who are doctors undergoing additional training — with Seton’s current annual expense for 284 positions $40.4 million. And a nonprofit formed by Seton and Central Health called the Community Care Collaborative contracts with various clinics and other health care providers to supply services.
Seton, UT and Central Health are bound tightly together by design, said state Sen. Kirk Watson, a Democrat from Austin who sketched out 10 health-related goals in 2011, including a medical school and a new teaching hospital.
“A key part of solving the funding puzzle was creating these symbiotic relationships. Now we’re cutting ribbons on something that has worked,” Watson said.
Johnston said the medical school is pushing hard to reshape health care from a fee-for-service model into a wellness-focused one. “It’s not that any kind of relationship with three distinct entities is going to be happy, smooth and kumbaya all the time, but given how different our three entities are, things are going quite well,” he said.
Still, UT and Central Health have come under criticism from activists who contend that state law restricts the health district’s spending to indigent care and that its funding of the Dell Medical School appears to have been improperly used for faculty and staff salaries. Central Health and UT officials say that their partnership is redesigning and improving the delivery of health care to indigent patients and that underwriting faculty and staff salaries in that effort is legal.
The closing of UMC Brackenridge creates a financial challenge as well as an opportunity for Central Health, which owns the 14.3-acre property that includes that hospital, a parking garage and a clinical education center. Central Health has been leasing the property to Seton for $34 million a year, and most of that revenue stream will dry up.
The health district plans to generate new income by leasing for a high-density, mixed-use development that could include housing, restaurants, shops, a hotel and medical offices. Plans to invite proposals from developers are on hold while the City Council considers whether to designate a Capitol view corridor that could limit building heights.
“We believe we have a once-in-a-lifetime chance to bring forward a vision of a model healthy community and make it a reality on this property,” Garbe said.