The evolution of the U teaching hospital

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We were excited to see that the University of Minnesota’s Board of Regents agreed to enter into a letter of intent to regain control of its hospitals and clinics from Fairview (front page, Feb. 10, and “An integral future for U’s medical center,” editorial, Feb. 18).

We are among the university and physician leaders who were at the table when the university transferred its hospitals to Fairview Health Services 28 years ago. Today’s environment differs greatly for both the U and Fairview, and based on all we’ve learned from experience, we believe it’s time for the university to create a health delivery system to support the growth of its programs and meet the needs of the state.

To be clear, none of us initiated the merger effort, but we were charged with working to create the necessary agreements to make the relationship successful once the deal was reached.

At that time, the health care environment was undergoing rapid change, and the medical school and its hospital struggled to respond with an equal level of urgency to a consolidating medical marketplace and new forms of contracting by large health care payers and emerging HMOs.

The impact of managed care and of payers’ reduced willingness to support the costs of the core academic missions of the university created a problem for the education and training of physicians and other health professionals. The incremental costs to hospitals and clinics that provided educational experiences for students and trainees were borne by each site and passed on to insurance companies and ultimately patients.

Another issue leading to the transfer was the rather unwieldy structure of the individual practice groups within each department of the medical school. At that time, an insurer needed to contract individually with the departments of surgery, medicine and/or pediatrics, etc., and that created issues for coordinated care as well as for payers.

The environment of the 1990s led to the decision to align with an external, more market-driven system. After review of a number of options, the university made the decision to merge with our neighbor across the river, Fairview Health Services, that was seeking a partner to provide a range of specialists for its community-based system of hospitals and clinics.

Although we have retired from our roles with the university, we stay connected enough to recognize the profound shift in speed and efficiency of health sciences enterprise operations. The U now features a unified clinical entity that is comprehensive, stable and functional in a manner that did not exist in the late 1990s. A key example was the U’s rapid response to the COVID-19 pandemic, from the basic science discovery of the spike protein of the virus itself to the remarkable speed and partnership with Mayo Clinic to launch a statewide testing program delivering 20,000 daily tests within weeks.

The medical school’s faculty physicians today are fully integrated as University of Minnesota Physicians, a strong multi-specialty group practice that delivered care in more than 1.2 million patient visits this past year alone. Some of us believe that if UMP had been in place earlier, the merger may not have been necessary. Today UMP practices in clinic and hospital sites around the state, where its multiple specialists have mature collaborations with systems beyond Fairview, including HealthPartners and CentraCare.

By 1998 the state of Minnesota, under Gov. Arne Carlson’s administration, had funded the Medical Education and Research Costs trust fund that supports those hospitals and clinics that train future health professionals for Minnesota, removing that issue from the table.

Last year’s proposed merger of Fairview with Sanford Health would have shifted control of the core facilities of the university’s clinical training and research to an out-of-state board. And we agreed then with the voices saying that was simply not appropriate for the state’s only public academic health center.

We believe that the university through UMPhysicians and its health professional schools needs to be responsive to the medical and cultural interests of Minnesota. We believe the university through UMPhysicians needs to be independent of any out-of-state entity and be affiliated with all of the health systems in the state to meet the care needs of both rural and urban communities.

We believe the university can take the knowledge and experience of increasing responsibility for managing the joint clinical enterprise with Fairview and apply it to its next chapter when it resumes control of the operations of its academic health clinical enterprise.

Dr. Frank B. Cerra is former senior vice president for health sciences at the University of Minnesota. Dr. Roby Thompson was founding CEO for UMPhysicians. Keith Dunder is a former hospital counsel.