State explains about-face on University of Iowa hospital in North Liberty


HR King
May 29, 2001
In explaining its reversal of an earlier decision to deny University of Iowa Health Care permission to build in North Liberty, Iowa’s five-member State Health Facilities Council highlighted the role semantics played in their about-face.

Although UIHC in reapplying for a state “certificate of need” didn’t amend its project cost or size, officials did change how they described it — and the council highlighted that as a “significant” difference between the initially rejected and subsequently approved applications.

“The prior application proposed the establishment of a new institutional health facility which would have resulted in a new acute care hospital in this service area,” according to a recently-released written justification of the council’s 4-1 approval in August. “This proposal does not result in the establishment of a new institutional health facility nor the addition of any licensed hospital beds.”

The original application, denied in February, indicated “UIHC intended to establish a ‘general acute care hospital’ providing services similar to those offered at a community hospital or outpatient surgical facility,” according to the council decision. “This proposal instead aims to expand access to tertiary care and enhance the UIHC’s teaching and research missions.”

UIHC in its revised application nixed the “hospital” descriptor by instead characterizing the project as a “modernization of UIHC’s existing institutional health facility.” University, UIHC, and state officials since have referred to the project as a hospital, however.

“This new hospital will help us fulfill our teaching mission, our research mission, and our educational mission for Iowans at large, and really for the whole Midwest,” UI President Barbara Wilson said during an Oct. 14 groundbreaking for the project — held weeks after crews started moving ground, which happened only days after UIHC received state approval.

“High-quality care, top-notch medical training, expanded research opportunities, UIHC has established itself as a leader in each of these critical areas,” Gov. Kim Reynolds said during that event. “And I have no doubt that this hospital, when completed, will reinforce and strengthen that well-deserved reputation.”

Days after getting approval to build a $230 million, nearly 300,000-square-foot facility in North Liberty — UIHC revealed plans for its 60 acres at the corner of Forevergreen Road and Highway 965 actually involve 469,000 square feet of construction, bringing the total project cost to $395 million.

Because UIHC didn’t require a state “certificate of need” for 169,000 square feet of academic, research, and clinic buildings attached to the new hospital, that piece wasn’t discussed in the application and wasn’t addressed by the council in its recently-released decision on the $230 million proposal.

‘Limitations of collaboration’​

In the decision, council members noted they also were swayed by work UIHC did between the two applications to answer questions about less-expensive alternatives and potential collaboration with community providers — including the many who spoke or wrote letters opposing the endeavor.

“The prior application failed to establish that UIHC had adequately considered alternatives to the project,” according to the council’s decision. “This application included independent assessments regarding alternatives and new information regarding the limitations of collaboration or other construction alternatives to meet existing needs.”

Although the first application did include among its justifications for North Liberty expansion the role UIHC plays in treating the state’s sickest and most complex patients, it also reported up to 32 of its 36 inpatient beds would be dedicated to orthopedic-related inpatients and recovery.

“Orthopedic surgery would account for a significant portion of the initial service mix,” according to the original, rejected application. “Moving these high-volume, high-growth services to a new campus would not only decongest UIHC main campus but also provide a more efficient platform to accommodate growth.”

Community providers took issue with that, as orthopedics are key revenue-generators.

In UIHC’s subsequent application, it pulled language about orthopedics and focused largely on the facility’s need to physically grow; expand its teaching and research capabilities; and up its capacity to take transfers — keeping Iowa’s sickest patients needing “tertiary care” from leaving the state to get it.

“Tertiary care is different than primary and secondary care in several respects,” according to the council’s decision. “Tertiary care requires more space and technology than community care; tertiary care requires dedicated teams with providers across many specialties.

When asked whether UIHC still plans to move orthopedic beds from its cramped lower-level space on the main Iowa City campus, officials said plans for the North Liberty campus “remain flexible as we continue to evaluate and determine which clinical specialties will be offered on the new campus based on patient demand.”

“Based on this patient demand, orthopedic subspecialties may be included at the new location.”

Since the UIHC approval, Steindler Orthopedic — based in Iowa City — has aired plans to build an ambulatory surgery center and orthopedic clinic near in North Liberty, near the UIHC project. Steindler also reported an unnamed hospital system has approached it about a potential partnership to erect an inpatient hospital on its land.

But UIHC in its application stressed collaboration with local providers can’t address its need for more tertiary care capacity because the community hospitals can’t take complex cases as transfers and, in fact, send most of their sickest patients to UIHC.

‘Need for tertiary care’​

In between applications, the state council reported, UIHC asked a consultant to assess opportunities “to address the need for tertiary care through referral to existing community hospitals across the state.”

That analysis found 2 to 3 percent of UIHC inpatient days potentially could go to community hospitals, while the other 97 to 98 percent of patients aren’t appropriate transfers because they need more complex care; need unique clinical services unavailable elsewhere; have existing relationships with UIHC providers; or require behavioral health services unavailable elsewhere.

“This identified 2 to 3 percent of non-tertiary patients seek care from a wide variety of specialties and are needed at UIHC for its educational mission,” according to the council’s decision, which reported UIHC had more than 1 million ambulatory visits and more than 36,000 inpatient encounters in the 2019 budget year.

“The lack of capacity causes UIHC to turn down approximately 2,200 to 2,400 requested transfers each year for patients whose referring providers have independently determined those patients need access to UIHC,” according to the decision. “The Iowa Hospital Association estimates that over 6,800 patients leave Iowa annually for complex care.”

In articulating a long-range plan — something it failed to do with its first application — UIHC reported plans to address tertiary-care needs not just through the North Liberty expansion but by modernizing its existing campuses and continuing collaborative conversations with potential partners, “such as the proposed behavior health center of excellence with Mercy.”

The council got 69 letters of support for the North Liberty project and 87 letters opposing it.

“The letters and testimony establish that local providers know that they are not able to provide tertiary care nor meet the complex needs of patients when they transfer to the UIHC and that the statewide shortage of physicians and the UIHC’s commitment to medical education and training and biomedical research is imperative to grow the field,” according to the council’s decision.



HR Legend
Sep 16, 2003
Get denied? Just change a few words on the application and next thing you know your 230 million hospital gets approved, forever changing the healthcare landscape of the area.