As reported by The Hartford Courant, October 9, 2004.

A Healthy Rebound at UConn Center

Aggressive Strategy Irks Other Hospitals

By Hilary Waldman

Dr. Ralph Rosenberg was a little surprised the first time a salesman from the University of Connecticut Health Center stopped at his Avon office.

The Health Center was just a few miles away in Farmington, but years earlier Rosenberg had virtually stopped sending patients there for specialized care, particularly heart operations.

UConn, the general internist remembered, was a cumbersome place to do business. If he called for an appointment, he'd have to wait for a call back. Often, the call never came.

Then, a little more than a year ago, a Health Center representative appeared at Rosenberg's front desk, offering to bring the new chairman of cardiology to his office for a chat.

That visit, which wound up changing Rosenberg's mind about UConn, was part of a new competitive strategy that has helped the Health Center rebound from a potentially devastating financial crisis five years ago. With some extra cash from the state and an aggressive plan to recruit patients and all-star physicians and scientists, the Health Center is back on its feet.

But some neighboring hospitals grumble quietly that they wish UConn would confine its competitive spirit to the Huskies' basketball court.

'Season Of Darkness'

The Health Center's position as a player in Connecticut's health care market has changed drastically since 1999, when bleeding balance sheets prompted talk that the university might close the center's flagship John Dempsey Hospital.

Instead of grousing about competition, representatives of Hartford Hospital, St. Francis Hospital and Medical Center and New Britain General Hospital - all within short driving distance of the Health Center - gathered to discuss ways to keep the Health Center alive.

At the time, the Health Center had recorded a $12 million deficit. It lost another $12 million in 2000, prompting UConn's medical school dean, Dr. Peter J. Deckers, to declare that the facility was in a "season of darkness."

While the state and surrounding hospitals were committed to preserving the Health Center's medical and dental schools, the 204-bed John Dempsey Hospital had become a money pit, too small and inefficient to absorb the financial pressures brought on by penny-pinching HMOs and lowball prices paid by government health programs.

To save Dempsey, Deckers proposed a partnership with Hartford Hospital, a 150-year-old institution with 868 beds and a large group of doctors who had teaching positions and administrative titles at UConn.

But after two months of meetings with state officials at the end of 1999, the prospect of a partnership was dead. The city hospitals said they would not subsidize inpatient care at the smaller, suburban upstart.

The UConn Health Center was in a fight for its life. "We turned around and said if we can't do [a partnership], we're going to have to compete," Deckers said recently. "That ... was the best thing that ever happened to us."

First, the center identified three specialty areas in which it could make a name for itself: cancer care, heart disease and bone health, encompassing orthopedics and research into diseases such as osteoporosis. It just so happens all three are the biggest moneymakers for any hospital.

To define itself as a leader in medical research, the center recruited respected scientists and physicians from across the country with the goal of encouraging laboratory breakthroughs that eventually could be tested on and offered to Health Center patients.

Many of the star recruits wear two hats, as lab researchers and clinical doctors. One of them, Dr. Bruce Liang, 48, left the Ivy League's University of Pennsylvania two years ago to direct UConn's cardiology department.

In the lab, Liang is studying heart failure, a growing problem as more people survive heart attacks or simply live into their 80s and 90s with naturally weakened hearts.

In the clinic, Liang takes care of patients referred by community doctors, such as Ralph Rosenberg, for angiograms, angioplasty or heart-bypass surgery. When Liang arrived, he noticed that the demand for those services was very low, despite the presence of able doctors at the Health Center. Patients came to UConn by ambulance after a heart attack, but few were referred by their primary care doctors for non-emergency care.

"It was a really well-kept secret that we were good," Liang said. "Many didn't know we did open-heart surgery or angioplasty."

Reaching Out

With the help of Rick Daddario, the Health Center's outreach manager, Liang set out to change that. Daddario, a veteran of state government, likens his role to that of a pharmaceutical salesman. Making the rounds primarily in the Farmington Valley, he drops by doctors' offices regularly, offering lunch and assistance in hopes of generating demand for his product.

"My job is to educate," Daddario said. "A lot of them don't know we have an open [cardiac catheterization] lab and they were referring to our competitors."

If the physician seems interested, Daddario will offer to arrange a personal visit with one of the Health Center's new hot properties. Liang and Dr. Carolyn Runowicz, the new head of UConn's cancer center, are regulars at breakfast, lunch or after-work visits to community doctors' offices.

Liang met Rosenberg at 5 p.m. one day. Afterward, Rosenberg said he was impressed, but still wary.

"I said, `I'll give it a try. If it doesn't work, I'm not going to continue.'"

He referred one of his patients with a complex heart condition to Liang. The Health Center is now on his list of choices for good cardiac care.

At least partially as a result of the sales drive, beds at John Dempsey Hospital are filling up. On an average day in 1999, patients occupied only 129 of the hospital's 204 beds. This year, 158 beds were filled on any given day.

During the same period, the volume of activity in the hospital's outpatient clinics nearly doubled, from 132,500 patient visits in 1999 to 230,000 in 2004.

The on-campus doctors' offices are busier, too. In 1999, doctors in the UConn Medical Group treated 341,000 patients, compared with 507,000 patients in 2004.

Word of UConn's revival seems to be making its way to the Internet. Stanley Kulewicz, of Marlborough, had an appointment at a nearby community hospital for an examination of his blocked carotid artery last year. But his daughter, who works in the health care field in Boston, researched his options online and suggested UConn or Yale-New Haven Hospital. She told him Liang at UConn was "one of the best in the country."

Liang found that Kulewicz's carotid artery, the main conduit of blood to the brain, was 95 percent blocked and damaged by ulcers. After the blockage was cleared during a three-day hospital stay, Kulewicz, 76, said he feels great and is sold on the Health Center.

State Sen. Toni N. Harp, D-New Haven, who was involved in the efforts to save the Health Center and is now Senate chairwoman of the legislature's appropriations committee, said one measure of the Health Center's success is that it has not returned to the Capitol seeking more state money.

In 2000, the state approved a one-time $20 million bailout for the Health Center. Since then, the center has survived on the roughly $73 million a year provided by state taxpayers, plus what it has raised. The Health Center's total budget in 2004 was $506 million.

"We wanted them to compete," Harp said. "The other hospitals in the area wanted them to shut down, but we wanted them to be aggressive."

A Hospital War

"I think this is one of those major success stories," said Marc Ryan, the state budget director, who in 1999 thought all parts of the Health Center, including the medical and dental schools, might be doomed.

While officials of Hartford and St. Francis declined to comment for this story, radio advertisements and highway billboards make clear that a hospital war is going full throttle in the Hartford area.

On billboards, UConn touts better care through research and education. St. Francis cites its inclusion on a Top 100 hospital list. Hartford says it has "The most top-ranked doctors in Connecticut. Period." On the radio, well-known UConn professor and author Gina Barecca hawks the Health Center. The other hospitals parry.

At a time when hospitals are fighting over the cream - patients with private health insurance - UConn's entry into the fray had to raise the stakes. Surrounded by some of the Hartford area's wealthiest suburbs, the Health Center offers the comfort and convenience of a suburban setting with free parking. Add aggressive marketing and a better reputation to the mix and insured patients might decide not to drive into Hartford for treatment.

Even with those advantages, the Health Center is not immune to the financial pressures that have plagued most hospitals for nearly 10 years. Low rates paid by Medicare and Medicaid, the government programs that pay for the bulk of hospital care, and health insurers that constantly demand better deals, leave hospitals struggling to make ends meet.

While the Health Center celebrates its rebound, Deckers, the medical school dean, is quick to remind that in the hospital world, a great year is measured by a profit of less than 0.1 percent - barely a squeak-by margin in any other business.

To thrive, he said, the hospital must be aggressive in attracting private contributions and research grants.

And there are challenges ahead, said Claire Leonardi, chairwoman of the Health Center's board of directors. More than 30 years old, the Health Center's buildings are cramped and outdated. Technology needed to keep up with the latest techniques and diagnostic procedures is extremely expensive.

"I do believe it's sustainable," Leonardi said of the recovery. "But you can't sit and wait. You can't take your eye off the ball."