You may have seen the gleaming tower with the University of Kansas Health System sign at the top, or you may have weaved through the construction zone around it at some point this year.
The tower is Cambridge North, an 11-floor expansion that is set to open Tuesday and that will eventually add more than 150 beds to what is already the largest hospital in the Kansas City area. It’s the latest addition in a two-decade building boom that has made it hard to remember what KU Hospital used to look like.
Chris Wittkopp remembers. As a longtime KU employee, Wittkopp doesn’t like to admit it, but she had her second child at a different hospital in 1982 because she was so unimpressed with the experience of having her first at KU.
“I had to go down the hall to take a shower,” Wittkopp said, “and we lined up to take a shower.”
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Just 20 years ago, KU Hospital was struggling to stay afloat.
In 1997, a consulting group issued a report stating that the hospital, then under state control, was in danger of losing $20 million a year.
With the hospital at risk of closing or being sold, the Kansas Legislature made a crucial decision: turn control of the University of Kansas Medical Center’s clinical care and its 2,200 workers over to an independent hospital authority board. The board would hire the administrators, the administrators would take charge and, aside from about a month’s worth of start-up money from the state, the hospital would have to figure out how to make it on its own.
Bob Page, now the hospital’s president and CEO, was vice president and COO under Irene Cumming when the hospital authority took over. Page said state leaders weren’t exactly crushed to have it off their plates.
“We were pretty much patted on the head and told, ‘Don’t call us; we’ll call you,’” Page said.
In the first seven years after the board took over, it authorized $437 million in capital improvements and new construction. That “spend-money-to-make-money” ethos has driven dramatic growth.
The hospital is now the hub of a health system that reaches throughout the metro area and sees 750,000 patients a year. The main campus on Rainbow Boulevard has almost 1,000 beds, a nationally recognized cancer center and, with 6,500 positions, is the largest employer in Wyandotte County.
The University of Kansas Medical Center, the academic side of the hospital that remains under state control, is the county’s second-largest employer at 4,000 positions.
Other Kansas City health systems have also grown dramatically in the last two decades. St. Luke’s opened two new hospitals in the south and east parts of town and invested $330 million in its heart institute. North Kansas City Hospital opened a new emergency department and cardiovascular center, and its Pavilion project almost doubled the hospital’s bed space between 2000 and 2005,
HCA Midwest, Shawnee Mission Health and Olathe Health all finished $100 million-plus expansions within the last 10 years and Truman Medical Center, Children’s Mercy Hospital and the University of Missouri-Kansas City’s medical schools joined forces this year to form an entire “health sciences district” on Hospital Hill.
But none of them had as far to go as KU.
The decision to break away from the state came at a critical moment. Kansas City’s health care market was growing and KU Hospital, built in 1906, was struggling to compete.
The roof leaked. Equipment was so old no one could service it. Patients and even people who worked there said the hospital’s reputation wasn’t great.
“When people had a bad experience here at KU they would say awful things like, ‘I wouldn’t bring my dog to KU,’” said Paula Miller, who started working at the hospital in 1976.
Kari Bruffett, a former KU Hospital administrator who is now the policy director of the nonprofit Kansas Health Institute, said the hospital’s reputation had already begun to improve when she worked there from 2003 to 2011 and has continued to improve since then.
“As far as being seen as ‘Hey yeah, if I have a loved one who has health care needs, where do I want to send them?’ KU Hospital at one time wouldn’t have been top of mind,” Bruffett said. “Now it is top of mind, along with some of its competitors and counterparts in the Kansas City market.”
Fitch Ratings, an independent credit rating agency, upgraded the hospital authority’s bond rating this year, saying its financial future looks solid.
Ashish Jha, the faculty director of the Harvard Global Health Institute, said it has gained a good reputation even outside the Kansas City area.
“The brand of the University of Kansas, and I look at this from a national picture, is that it’s a premier academic medical center, and for people who want to practice in that environment, it’s a great place to be,” Jha said.
The hospital still has challenges. Its emergency room wait times are about twice the national average, according to federal data, and its readmission rates are also worse than average.
An inspection by the federal Centers for Medicare and Medicaid Services last year turned up 13 violations, some of which are now part of a high-profile lawsuit by a Shawnee woman who says hospital staff misdiagnosed her with pancreatic cancer, performed an unnecessary surgery and then sought to hide it from her.
But followup inspections have found fewer problems, and KU is in a far better position to weather those challenges than it was 20 years ago.
Arif Ahmed, an associate professor of health administration at the University of Missouri-Kansas City, said breaking away from state control made the hospital more agile and its leaders used that freedom to rebuild its infrastructure, retrain its workforce and improve patient care.
“All of those translated into their reputation growing,” Ahmed said.
Wittkopp started working at the hospital in 1974 as a medical records file clerk, worked her way up through various positions and is now director of quality outcomes and public reporting.
She remembers what it looked like when she started.
“It was really kind of a depressing facility,” Wittkopp said. “It really reminded you of a state facility in the look of the building.”
In the six years prior to the hospital authority taking over, the state made a total of about $46 million in capital investments in the facility.
That didn’t go very far in the medical realm, even 20 years ago. Dennis McCulloch, the hospital’s longtime public relations director, said he remembers a story about hospital leaders meeting one year to decide how to spend their capital outlay.
The meeting was brief: They voted to approve the purchase of a new imaging machine and then they were out of money.
Once the hospital authority took over, the building boom began.
In addition to renovating existing buildings, KU added a $77 million Center for Advanced Heart Care in 2006 and a three-level, $36 million Cancer Center and Medical Pavilion in 2007.
That enabled KU to offer more services, Ahmed said, and also adapt to new reimbursement models that favor hospitals that control outpatient services as well as inpatient care.
He said KU is one of several hospital systems that have taken advantage of low interest rates to fund major expansions.
“You see construction and efforts to grow pretty much everywhere you look,” Ahmed said. “Sometimes at the expense of some of the smaller competitors.”
The KU construction has only ramped up in recent years, on both the main campus and at satellite clinics. In total, the health system has made more than $1 billion in capital investments since the hospital authority took over.
How has KU paid for it? Some through philanthropy, but also through debt, in the form of bonds that the health system will pay off over many years.
As of April, the hospital held more than $300 million in bonds issued from 2004 to 2015 either by the hospital authority or by the Kansas Development Finance Authority on behalf of the hospital authority.
The hospital authority issued another $190 million in bonds in April to finish the Cambridge North project and pay the outstanding debt of Hays Medical Center in Hays, Kan., which KU acquired in January.
When the new bonds were announced, Fitch Ratings upgraded all the hospital authority’s debt, saying it appears to be good for the money.
“The upgrade to ‘AA-’ from ‘A+’ reflects the significant growth that KUHA has experienced,” Fitch Ratings wrote.
Fitch Ratings also said the hospital has a “significant presence as a provider of high-end services to a large service area.”
As KU upgraded, the beds began to fill. Its total discharges numbered about 16,000 in the final year under state control. Last year it had more than 55,000.
Wittkopp said the full weight of the change hit her one day while she was doing a shift in patient placement.
“I went ‘Oh my, we have so many patients and we don’t have places to put them,’ ” Wittkopp said.
Within months of the hospital splitting off from the state, Page asked Miller, who was then working in the hospital’s lab to be part of a four-person team that would teach all the employees how to interact with patients.
“I said, ‘Bob, you know I’m a tech in the lab, right?’ ” Miller said. “ ‘Lab people don’t really like people, you know.’ He’s laughing and he says, ‘Oh that’s not you, Paula. I see you in the hallways.’ ”
What Page had in mind was essentially classes on bedside manner. He called it “customer service.”
Miller said she initially pushed back, telling Page that the hospital served “patients,” not “customers.”
“He said, ‘Well, Paula you’re going to learn a little bit about health care here,’ ” Miller said. “ ‘They really are customers.’ ”
Over the course of a year, Miller and her three colleagues retrained the entire workforce.
She said at first some of them derisively called it “Paula’s Be-Nice Class,” but eventually warmed up to it.
Every new hire also had to go through the classes.
Patient satisfaction numbers crept steadily upward, from about 10 percent in 1999 to about 90 percent in 2007. It’s been between 77 percent and 97 percent every year since.
“I think they have grown leaps and bounds in public perception,” Ahmed said.
Ahmed said that metric is important to a hospital’s bottom line. Since 2012, patient satisfaction surveys have been factored into Medicare reimbursements.
Almost every hospital now bills itself as a place that treats patients like family. But Ahmed said he experienced it himself when he’s had loved ones treated at KU.
Miller has also experienced it. She was working at the hospital last year when she had a heart attack and collapsed, mid-sentence.
“First time I’d ever been an inpatient here (and) I am so over the moon about this place,” Miller said. “... People took great care of me.”
KU had yet another challenge in turning itself around: keep more patients from dying.
In the final year before the hospital authority took over, KU’s mortality index was 1.14. That meant the hospital was losing about 46 more patients a year than would be expected, as calculated by the University HealthSystems Consortium, a group of academic medical centers.
Ahmed said KU leveraged its connection to the academic medical school even after the clinical side of the hospital split off.
Hospital clinicians used medical center research to bring in new treatments at places like the cancer center, which got National Cancer Institute designation in 2012. And they used the medical center to recruit clinicians interested in doing both research and hands-on patient care.
Steven Simpson, a critical care pulmonologist, went to medical school at KU in the 1980s. After a fellowship in Chicago, KU hired him back in 1998, when the hospital was at its most precarious point.
“Which was not something they told me when I interviewed,” Simpson said.
Simpson wanted to work on sepsis, a blood poisoning caused by infections. It’s hard to diagnose and, if not checked immediately, can progress within hours to septic shock, organ failure and death.
“It’s unrecognized (by the public) as a killer, but it is,” Simpson said.
Simpson, who is also a professor at the medical center, has led a hospital-wide effort to educate staff on how to recognize sepsis. He established a rapid response team of nurses and respiratory technicians trained to handle the illness.
Simpson said the mortality rate from severe sepsis at KU has dropped from 49 percent to about 7 percent.
“Things like a sepsis response team would have never happened if we were still the same as we were in the late ’90s,” Simpson said.
By 2016, KU’s overall mortality rate had dropped to 0.692, meaning the hospital was experiencing 265 fewer deaths each year than expected.
Kansas Senate Minority Leader Anthony Hensley, who voted for the creation of the hospital authority, called the turnaround at KU Hospital “one of the shining examples of where the legislature actually did something that turned out to be very positive.”
“It got to a crisis point where we had to do something different,” said Hensley, “and creating the hospital authority was the best move we could make.”