Meeting Minutes: October 19, 1995

Attendance

Guests: James McGill, Executive Vice President; Ken Hutchinson, Associate Vice President; Andrew Twaddle, Professor of Sociology; and, Mark Hulse, Campus Computing.

Council members present were: Edward Adelstein, Gary Allee, Craig Anderson, Joe Donaldson (for Lloyd Barrow), Hardeep Bhullar, Benedict Campbell, Joe Charlson, Leonard Forte, Jere Francis, Allen Hahn, Peter Hall, Edward Hunvald, Peter Hasselriis (for Nancy Knipping), Charles Knowles, Marian Minor, Alex Pickard, Glenn Pierce, Patricia Plummer, Don Ranly, Ray Rothenberger, Dennis Sentilles, Mary Ellen Sievert, Susan Taylor, Harry Tyrer, Gilbert Youmans, Anne Edwards (for Bob Almony, Librarians), and Roy Utz (Retirees). Absent were: Jean Hamilton, Ron Plain, Michael Porter, Sara Walker, and Mabel Grimes (Black Faculty&Staff).

Approval of Minutes

Chairwoman Patricia Plummer brought the meeting to order in Room S110 of the Memorial Union at 3:40 p.m. The minutes of the October 5 meeting were approved as presented.

Report of Officers

Pat Plummer invited the Faculty Council to join in extending our sympathies to the family of Don Faurot who passed away this morning (October 19).

Professor Plummer read two letters, one dated October 17 from the Governor, Mel Carnahan. The Governor noted the strong position the Faculty Council had taken; he will take them into account in any contact that he has with the University Hospital. The second letter, dated October 11, 1995, was from the President of the University, George Russell. The President stated he was in agreement with the Faculty Council's concern for the teaching research consequences of a partnership with Tenet HealthCare. He stated that Dean Bryant capably represents the interests of the Columbia campus, and he feels free to call on any other expertise within the University.

Professor Plummer announced the General Faculty Meeting on Tuesday of next week (October 24) and the first Faculty Forum with the President of the AAUP and Provost Sheridan (October 25).

Action Items

Faculty Representation On International Programs. It was moved and seconded to create four new groups to advise on international activities. This will include a council on international initiatives, regional working groups, study abroad advisory council, and international advisory council. Motion passed without dissent.

International Affairs Council. It was moved and seconded to inactivate the current International Affairs Council for this year. Motion passed without dissent.

Discussion Items

Report from the Health Oversight Task Force, Andrew Twaddle, Mark Hulse Co-Chairs. Dr. Twaddle discussed the Health Plan Oversight Task Force, a committee which is half faculty--half staff, whose mission is to monitor the health insurance program from the standpoint of faculty and staff. The committee solicits faculty and staff input with regard to the screening process that GenCare goes through for emergency care or out-of-area care and the issue of GenCare paying providers. Several anecdotal stories and direct complaints have indicated that there are problems with GenCare's screening process and that there might be a pattern in which GenCare simply pays a portion of the bill and waits to see if either the provider or the patient takes care of the rest. In an experience this past summer, GenCare suggested that a patient with a collapsed lung to be placed in an airplane for surgery in Columbia. The attending physicians contacted GenCare and the question asked by the clerk was, "Will he die today if you don't do surgery?". The committee will meet on the 16th of November to review the response from the solicitations from faculty and staff. It may be possible that the providers themselves may be dilatory in their billing of GenCare.

Mark Hulse commented that 150 complaints dealt with start-up problems. Professor Plummer reread the Faculty Council's resolution of last winter (the resolution was that GenCare should not micromanage the patient/doctor relationship). The committee has taken no action but will include that resolution in their next report to the Chancellor. Further comments were made with the concern that there is no chiropractic care nor non-emergency or non- urgent care when away from the area. This is particularly a problem for the three months in the summer for individuals on 9 month appointments.

Plummer requested McGill's comments on health care. McGill responded that current thinking centers on the following issues.

  1. There is an argument that should GenCare be dropped, faculty might need to change primary care providers.
  2. The people should have a significant amount of choice in the particular kind of HMO and various service options they choose.
  3. The benefit structure of 80/60 needs to be improved to 100/80 with $15 co-pay for POS (HMO/POS).
  4. People who use more health care tend toward HMO coverage.
  5. Should we maintain plan E?
  6. Perhaps there should be decoupling of the campuses within the university.

A short discussion followed Dr. McGill's comments. Next follows extensive discussions on negotiations with Tenet. The Questions and Comments were offered by Council members with Answers/Responses coming from Dr. McGill.

University Hospital - Negotiating with Tenet

McGill spoke about the discussions with Tenet. The University Hospital requires major capital commitments for an ambulatory care center and for replacement of obsolete intensive care beds in a new tower. The price tag on these two projects is on the order of 70-75 million dollars. The rapidly changing environment in the delivery of health care raises the question of alternatives to spending the 70-75 million that will also keep the hospital on the leading edge and continue its success. Responding to the directive to look at alternatives, three basic courses arose. 1) Stay the course and strengthen the relationships with rural hospitals. The University Hospital relies very heavily on the flow of patients from areas outside the immediate area. Fifty percent of patients come from outside Boone County and the counties immediately adjacent to Boone County. 2) Sell the University Hospital outright; this did not have a lot of support. 3) Find an appropriate partner.

The partner would share in the capital costs necessary to keep the University Hospital on the cutting edge of quality medical care, and two, provide an expansion for the businesses that it required. The necessity for the latter arises from the need to provide financial coupling to those hospitals and physicians currently referring patients to the MU hospital. When managed care comes to those small towns, the special care (tertiary care) provided at the University Hospital may be cheaper in either Kansas City or St. Louis.

The process to find a partner was public, and there were four viable responses three from for-profit institutions and a joint offer from four not-for-profit groups. The latter did not make a specific offer but submitted a proposal for cooperation. In evaluating the for-profits, Tenet appears to be the best. By direction the administration entered into an exclusive negotiating period with a November 1 deadline. That deadline is absolutely unattainable and has been extended to November 15 (and subsequently extended to December 1). The University Hospital requires a partner that would do business for a long time, 40, 50, 100 years. A week from Friday (October 27) the Tenet people will talk with the University physicians and healthcare providers. There is a lot of work to do.

Questions and Answers

Question. Some physician providers and small schools involved with health sciences have not been invited to the discussion. There is an issue of compatibility of mission and vision which is absent. Response. McGill agreed philosophically that quality issues can be dealt with in addition to physician providers. Practically, competitive advantage has been given to those single individuals or close-knit groups able to negotiate and do deals.

Extensive discussions centered around the idea of the role of the medical school and the hospital and the associated biomedical science fields including Medical Informatics, School of Library and Information Sciences, Chemistry, Biochemistry, Physics and liaison with Veterinary School. Additional points made were the role of the Medical Center to have scientists and scholars involved in original research trying to understand the processes of diseases. That role is compromised if everyday the scientist is required to see a patient every five minutes for eight hours a day. Question. Where is the representation of the scholar in the discussions with Tenet? Many physicians can provide patient care but physicians who do original research require very specialized training. Could Chancellor Kiesler, who would represent the entire campus, be involved in these negotiations? When Tenet and the University reach an agreement, will there be a sufficiently long comment period and information disseminated to consider the consequences on all concerned? Also this is a major decision, looking for decades-long partnership, so a rushed-through decision should be avoided. Answer. Not at the present time. To get a decision done you want to keep the period of uncertainty short.

Comment. An opportunity is for the Medical School to improve in its psychological services. One of the people involved with mental health care delivery during the last twenty years is the Chancellor. Historically as a hospital gets larger, there is actually less mental health care delivery.

Comment. "I get many calls and I haven't had one positive call from anybody, the local town people, the politicians, workers at the University, workers at the Hospital for the deal with Tenet." The opportunity here is for the University to really change, not to be taken over, but to change. Is there support here that is not obvious? Answer. There is no sense of a groundswell of support. That may be because there is nothing specific for people to support.

Comment. There are moral issues. The partner must be ethical, moral and not do illegal things. Response: To be fair to Tenet you cannot saddle Tenet now with the sins of four or five years ago.

Question. Are there successful models we can draw upon? Response. The situation at the University of Southern California, its President says, is working very well. The University of Nebraska has reported good periods and bad periods in their relationship with the old AMI and Tenet. There was a rocky period when AMI was in the process of being bought or sold. That was a down. Remark. The CEO of their hospital board (in Omaha) was quoted in an Omaha, Nebraska, newspaper when he resigned saying he couldn't teach business ethics and remain on the board. Response. In any large institution you find detractors and supporters. Comment. The concern for the current operating system as opposed to what happened in the past is due to a crisis of confidence. Comment. Do not arrive to a final conclusion now but keep an open mind.

Question. Is there an independent disinterested authority that can independently evaluate any proposed deal?

Comment. The surrounding states look to this medical center for leadership in medicine. Fiscal aspect is only one part but the hospital has done quite well. The hospital has made a 20 million dollar profit and that is very good for a hospital. Comment. Finances are not a driving factor but they are a factor in maintaining the financial viability of the hospital. The core of the issue in addition to financing is to protect the core values of the programs, the products, education, research and the ties throughout the campus. Preserving all that has got to be front and center. There are factors that may detract, though, from the current very good bottom line. Question. The only discussion has been financial. How can anyone believe that research, teaching and community health will ever be a part of this product? There are many ways to build a network and managed care in rural hospitals to preserve the referral base without inviting someone to come in who knows nothing about our state, who could care less about our medical school, and wants to make money to pay their debt. One cannot get a patient record that isn't based in the business office. Clinical research has gotten harder every single year in terms of finding time, clinical space, and ability to hire personnel from our own hospital.

Comment. MU is the only public university in this state with a medical school and a major hospital. Where is the institute for molecular biology, where is the institute for heart disease? I don't hear those kinds of discussions. Comment. This means that we need to incorporate scientists in the discussion with Tenet. Comment. In the deal Tulane made with Columbia HCA, large amounts of money went to science and research. Is Tenet offering this? Response. Tenet is saying, here is a dollar amount that we will pay you. This is what Columbia HCA did. We have had no discussion on how the dollars will be spent. Question. When the hospital was not making money, campus G.O. funds made up the deficit. Funds coming from the sale should not be spread around the campuses.

Question. How can we get into the process? Response. (McGill) We're open to letters. I'll answer calls and have discussions with anybody. Comment. To provide us with information, you can send us email. All of Council is on a listserve as mufac-l@mizzou1. Question. What are the odds that this deal will go through? Comment. President Russell has excluded this campus from this decision. That has excluded many important constituencies. Comment. We're getting into a pool with sharks. Question. Will you provide an independent disinterested assessment of the deal? Comment. Wilson Report was not widely circulated. MU should pursue its rural mission. Comment. The state of Missouri is wealthy enough to support this academic medical center without a for-profit partner.

Closed Session and Adjournment

The Council then went into closed session and the meeting adjourned at approximately 5:25 p.m.

Respectfully submitted, Harry Tyrer, Recorder