Building a Medical Metropolis 

As the nation grapples with health care reform, UHealth continues to advance its own comprehensive medical plan for the community.

UHealth hospital

Editor's Note: We regretfully inform readers that Steven Guarin died on March 30, 2010 due to complications from a cord blood transplant. The entire Sylvester medical team is saddened by Steven’s passing, but grateful to have had the opportunity to know him and witness his courageous battle against cancer. Dr. Joseph Rosenblatt, interim director of the Sylvester Comprehensive Cancer Center and Steven’s physician, describes Steven’s death as “heartbreaking and humbling. He struggled with great courage and determination and maintained hope to the end. Steven’s remarkable story teaches us not to lose hope, but also that we still have much to learn.”

It’s the kind of e-mail that would make anyone’s day: “You’re my hero … I owe you my life,” 21-year-old Steven Guarin wrote to Miller School of Medicine cancer researcher Eckhard Podack.

Guarin was diagnosed with a rare form of lymphoma at age 18. The cancer spread rapidly. After aggressive treatment and two debilitating relapses, Guarin says he accepted that he was going to die. His doctors didn’t.

Hematology/oncology fellow Peter Hosein, who had been treating Guarin for two years, transferred his care to Joseph Rosenblatt, associate director for clinical and translational research at Sylvester Comprehensive Cancer Center, who got Guarin approved for an experimental drug containing an antibody created by Podack, Sylvester distinguished professor and chair of microbiology and immunology. It worked.

With his lymphoma in remission again and a cord blood transplant in the works, Guarin calls the treatment “a miracle.” He is deeply grateful to Podack and his entire UHealth team.

UM students“My first oncologist, Dr. Hosein, was behind me every step of the way and doing everything in his power,” says Guarin. “Dr. Rosenblatt [chief of hematology/oncology] had to fight tremendously every day while I was dying to get me approved on this medicine. These doctors really fight for you, and that is one thing about UHealth that makes it probably one of the best in the country.”

Guarin’s story illustrates the impact of South Florida’s only academic medical network. Powered by the Miller School of Medicine, UHealth—University of Miami Health System—serves a market of five million people and encompasses Centers of Excellence such as Sylvester, University of Miami Hospital, Bascom Palmer Eye Institute, the Diabetes Research Institute, and The Miami Project to Cure Paralysis; affiliates Jackson Memorial Hospital, Holtz Children’s Hospital, and the Miami VA Medical Center.

Although just over two years old, UHealth builds on decades of strength. U.S. News & World Report has ranked Bascom Palmer the No. 1 eye hospital
in the nation for six consecutive years. In addition to other high-ranking
clinical specialties, transplant, stroke, trauma, orthopaedics, and neurosurgery at Jackson Memorial are also well established and highly respected. At UHealth facilities across the region, more than 1,500 clinical trials are exploring best practices for curing, treating, and predicting critical health concerns.

Pascal J. Goldschmidt, senior vice president for medical affairs and dean of the Miller School as well as CEO of UHealth, believes it’s all about combining cutting-edge research, education, and a comprehensive menu of health services. “We’re one big practice,” he explains. “We’re 1,200 doctors. We all work together; we meet and talk aboutwhat we need to improve, opportunities, patients, safety—you name it. This is quite different from many other forms of practicing medicine.”

Pascal J. GoldschmidtIndeed, health care today can be more fragmented and complicated than ever. With private practices, a patient’s multiple doctors may never communicate, potentially resulting in unnecessary or duplicated tests, delayed diagnoses, or worse. But an academic setting provides a framework for multidisciplinary, comprehensive, coordinated care.

“The notion of UHealth from a strategy standpoint is, let’s identify the areas of opportunity and add new capabilities that weren’t there,” explains William Donelan, vice president for medical administration and chief operating and strategy officer. “Let’s create a brand identity, a culture to go with that, and some room to grow.”

Although its association with Jackson Memorial dates back to the medical school’s founding in 1952, the University never had an acute-care hospital to call its own until it purchased the 560-bed, all-private-room Cedars Medical Center in 2007. Renamed University of Miami Hospital, the facility has become a natural extension of the Miller School/ Jackson Memorial campus just across Northwest 12th Avenue—and a cornerstone of UHealth’s growth strategy.

“The University of Miami’s medical enterprise has benefited greatly from its 50 plus-year partnership with Jackson,” says Donelan, adding that Jackson serves a key social need, particularly with 30 percent of Miami-Dade County’s residents lacking health insurance. Jackson Memorial provides high-quality services to all residents, regardless of ability to pay. Because of the University’s partnership with Jackson, its patients also benefit from the renowned expertise of Miller School physicians and specialists. “But it is also true that it kept UM fairly centric to its downtown location. We didn’t reach out very far into the South Florida region,” Donelan adds.

UHealth’s growing footprint includes dozens of outpatient facilities from Palm Beach County to Key West. The expansion efforts seem to be working. Despite the dismal economy, it reports rising patient volumes and an annual revenue of about $1.5 billion.

With an eye toward serving professional athletes and weekend warriors alike, UHealth debuted a multidisciplinary sports medicine division in 2008, led by renowned orthopaedic surgeon and arthroscopic specialist Lee Kaplan, who came from the University of Wisconsin-Madison School of Medicine. “If I have a patient who hurts his knee, his stress goes up, his blood pressure may elevate,” explains Kaplan, who also serves as medical director for the Miami Hurricanes teams and Florida Marlins baseball. “Getting people back to the activities they love and that keep them healthy is critical.”

UM studentsAnother community benefit, notes Goldschmidt, who arrived from Duke University in 2006: Burgeoning academic health systems such as UHealth attract top-notch talent. “Excellent physicians choose to be in an academic center because they can care for their patients and also advance the field of medicine with research and education,” he says.

University of Miami President Donna E. Shalala, who was U.S. Secretary of Health and Human Services for eight years, agrees. “University health systems are truly the pillars of health care in this country,” she says. “Physicians at universities are the ones practicing evidence-based medicine and setting the standards of care that others follow. Our scientists are able to formulate the next breakthrough treatments in our laboratories right here on campus and develop clinical trials available first to South Florida residents.”

Two Miami-Dade County octogenarians were the first recipients of a revolutionary treatment for aortic stenosis—a narrowing of the aortic valve—which they had developed years after previous heart surgeries. Left untreated, aortic stenosis kills 90 percent of patients within a year, says William O’Neill, executive dean for clinical affairs and an acclaimed interventional cardiologist. Because of the men’s age and medical history, another major surgery wasn’t an option. In 2008, they were enrolled in O’Neill’s FDA-approved percutaneous valve replacement trial at UM Hospital, the only Florida institution and one of just a handful in the entire country to offer it. On the same day, each man received a new heart valve via a catheter inserted into his leg. Both returned to their normal activities in under a week and went on to full recoveries. The Miller School has since approved more than 300 others for this new procedure.

Another cardiovascular study showing “very, very promising” results, says O’Neill, is led by Joshua Hare, director of the Miller School’s new Interdisciplinary Stem Cell Institute and a professor in the Cardiovascular Division. Hare is investigating whether adult stem cells injected into damaged hearts through a catheter can stimulate muscle regeneration.

surgeonWith heart disease the leading cause of death in the U.S., it’s no wonder UHealth is committed to becoming a nationally recognized vascular care destination. Minimally invasive procedures are also a growing priority—they’re easier on the patient and can significantly shorten expensive hospital stays.

Michele Chulick, associate vice president and executive director for clinical operations, touts UM Hospital’s $13.5 million state-of-the-art cardiac catheterization labs, the only ones of their kind in South Florida, and a new 128-slice CT scanner, which provides a quick, noninvasive 3-D view of the arteries. And Goldschmidt says he is currently recruiting a physician who uses a robot to perform bypass surgery in such a targeted, precise way that the patient can usually return home the next day.

Another vital piece of the health-care puzzle is service. In this area UHealth has set high standards for its physicians and 8,000 staff members, instituting a new initiative called UCare—U Can Achieve Real Excellence. “You can’t be what we aspire to be without this dimension in place,” says Donelan, who arrived at UM in 2006 after helping to build Duke University’s health system.

Studer Group, a health care consultancy, is working with UHealth to assess and improve patient satisfaction, which is measured against other like facilities across the nation. Chulick explains that in addition to patient satisfaction and service, there are benchmarks for personnel, quality, growth, and financials. “Through UCare, we work together to implement the changes necessary to achieve a goal,” she says.

To that end, plans are under way to computerize patient records, patient-doctor communications, appointments, prescriptions, and billing and insurance. Electronic records will give UHealth doctors instant access to a patient’s complete medical history, empower patients to retrieve their records and lab results, and facilitate one-stop care.

Implementation of this electronic health record system is scheduled to begin in July. “This will be transformational,” says Chulick, who was involved in a $240 million expansion of the Detroit area’s 1,000-bed Beaumont Hospital before joining UHealth in 2007. “This will not only improve patient care; it will improve patient safety.”

Helping UHealth to maintain momentum in tough times is the
$60 million in federal stimulus funding Miller School programs won last year.

“That’s the one positive thing coming out of this economy,” says Donelan.

Goldschmidt points out that the vision for growth was already in place, “but we were right on time to get maximum support from stimulus package resources.” Asked what else is on the UHealth horizon, he describes plans for a state-of-the-art ambulatory center near the Coral Gables campus, the expansion of existing UHealth ambulatory centers in the Miami Health District, where the medical campus is located just north of downtown, and construction of the Life Science and Technology Park, a biomedical research incubator expected to energize research and stimulate the economy.

These projects, Goldschmidt says, “further increase opportunities to deliver great medicine and great science, serve the community, create new jobs, increase the reputation of the brand, and help our partners at Jackson Memorial as well as raise their level of medical excellence.”

They also continue to establish the University as a medical destination—whether the patient lives down the street, in other parts of Florida, across the United States, or abroad.

“I was always amazed that people would fly out of Miami to get care in northern cities,” Goldschmidt says. “I think it is fair to say people don’t need to fly anymore to get outstanding care.”

In the past year alone, numerous high-profile cases have merited international attention. To name a few: a first-in-the-U.S. procedure at Bascom Palmer that restored a Mississippi woman’s sight, lifesaving surgery to remove a 1.8-pound tumor from a Miami newborn’s airway, and the unprecedented emergency transplant of vital insulin-producing cells into the liver of a U.S. airman wounded in Afghanistan.

O’Neill, who previously oversaw the development of a Detroit health system, believes UHealth’s prominent stature can elevate that of the entire community. “We hope we will serve as a model for the other practitioners in South Florida for how high-quality health care can be delivered,” he says. “What I saw in Michigan was that when you bring high quality, the other hospitals step up to the plate to compete. The entire health system in South Florida is going to improve.”

Nancy Dahlberg is a Miami-based journalist.

 

Surgeon General’s Findings

Ana Viamonte RosAna Viamonte Ros, B.S. ’79, M.D. ’83, ascended to the role of Florida’s first-ever surgeon general and secretary of the Florida Department of Health in 2007, on the brink of a particularly challenging period: a historic health care debate poised to affect states dramatically, concerns about the growing threat of the H1N1 virus, and an economic crisis that has resulted in a growing population of uninsured and underinsured. Viamonte Ros describes her plans as Florida’s top health official and her view of how the University of Miami’s network of hospitals and clinics fits into them.

Q: What is the University of Miami Health System’s significance to South Florida?
A: I think it has become a vital component of health care in South Florida. It has a tremendous history of excellence. I know that I received a fabulous education—not only in the medical school, but also in undergraduate studies. Even back then, certain departments were world-renowned. In the last five years the school has recruited a lot of people to work on the internationally significant genome project. And I can’t imagine a better training for doctors than UM’s partnership with Jackson Memorial Hospital.

Q: How does your office work with the UHealth System? What are UHealth’s strengths?
A: We work very closely with all the university systems. We have several committees where all the deans of the state’s medical schools meet. I see the Department of Health as a convener; we’re able to bring the state, academic, and private institutions together to coordinate resources. The University’s strengths are in its outreach to the community, especially those in need. The dental clinic programs, the autism van used for screening purposes, the nurses and medical students the University can bring in to do this outreach—these all become vital to the community you’re serving.

Q: What are Florida’s most urgent health care issues, and how do you plan to address them?
A: I’ve had the opportunity to visit all 67 counties, and our biggest health issues have to do with the significant population of uninsured. Fifty-five percent of all births in the state are Medicaid births. We’re seeing that many more folks, not just the poor but working poor, are uninsured or underinsured. So the challenge is how to address the ever-growing number of people seeking health services in a fiscally sustainable manner.
The outbreak of the H1N1 virus has shown that every state needs a robust infrastructure to meet its demands. We’re fortunate it’s not a severe outbreak, but being prepared for H1N1 is one of our top priorities. As of December 30, 2009, we’ve had 187 deaths. The state has ample supply of H1N1 vaccine and we encourage anyone interested in receiving the vaccine to contact their primary health care provider or local county health department.

The other two major priorities right now are obesity prevention and tobacco prevention and cessation.