Everyone wants to provide the best health care for the region and to make Kansas City a leader in life science research.

The question is how to go about it.

Backed by a task force report suggesting more cooperation among bioscience entities, the Kansas University Medical Center is exploring new alliances with hospitals in Kansas City.

But KU Hospital, which always has had the closest ties to the medical center, says some of those alliances could be bad for its business. And legislators – who will host a hearing on the issue Monday – are concerned that state resources will be flowing over the Missouri border.

“There have been a lot of discussions happening,” said state Senate President Steve Morris, “and some confusion.”

On the table

The latest rounds of negotiations have produced a 10-year, $400 million proposal from the KU Hospital to the medical center, the university branch in Kansas City, Kan., which includes the schools of medicine, nursing and allied health.

The money would include support for professor salaries, a cancer facility, an ambulatory care building and other items. But it also comes with conditions, most notably – excluding St. Luke’s Hospital in Kansas City, Mo. – as a site for full residency affiliations.

Meanwhile, philanthropic leaders on the Missouri side of the border have pledged about $200 million as an incentive for the medical center to form affiliations with entities other than KU Hospital. Those may include St. Luke’s, Children’s Mercy Hospital and Truman Medical Center.

KU Hospital and KU Medical Center have been closely linked since they officially split in 1998. That year, a separate hospital authority was formed to govern the hospital, and, without state bureaucratic restrictions, hospital revenues have soared.

KU Hospital remains the primary teaching hospital for KU, and university faculty share clinical positions in the hospital.

Medical ‘leap’

Barbara Atkinson, executive vice chancellor for the medical center, said expanding affiliations with other institutions was a way to strengthen the university’s medical education and bolster life sciences research. That, in turn, could help the bioscience industry in the entire Kansas City area.

“For us, it’s about our ability to make a transformational leap in where our research abilities are,” Atkinson said.

Adding residencies at St. Luke’s, she said, would give fledgling doctors a different type of hospital experience. St. Luke’s, she said, is a traditional tertiary care hospital, meaning it provides much follow-up care for patients.

Atkinson said most university medical centers offer full residency programs at more than one hospital. She also noted that, though it’s improving, support from KU Hospital to the medical center is well below the national average for peer institutions.

Adding another collaborative hospital also may help in the university’s quest to receive “comprehensive cancer center” designation from the National Cancer Institute, a distinction that would bring additional clinical trials to the Kansas City area.

“This is a way to really expand the scope of the medical center and grow programs,” Atkinson said of possible affiliations.

Hospital concerns

But KU Hospital leaders are worried about what a shift in alliances might mean for their institution.

“There are business risks for the hospital and the clinical faculty,” said Irene Cumming, president and chief executive officer of the hospital. “Those business risks, if not properly resolved, could destabilize the financial position of the hospital and the faculty.”

Sending some residents to St. Luke’s, Cumming said, could dilute the KU brand name. One of the conditions of the hospital’s $400 million offer to the university was that other hospitals could not use the KU brand in marketing.

“That brand name – the University of Kansas and the academic medical center – are a distinguishing factor for us,” Cumming said. “It’s an asset. We have to be very careful how we use it.”

Cumming said she also had concerns for how any changes might affect clinical faculty, though she didn’t provide specific examples. She said she didn’t think biosciences in Kansas City would be harmed if the St. Luke’s residencies were excluded from any deals.

“Everyone has a different opinion on that,” Cumming said. “I believe we have a process that will address the concerns.”

Common ground

Both Cumming and Atkinson said they have hopes for resolving the issues to the satisfaction of both the hospital and the university. The two entities have been meeting every other week for negotiations, though no timetable has been set for any decisions.

“We certainly will do absolutely nothing to harm the hospital,” Atkinson said.

Atkinson said the affiliation discussions represented a new line of thought for health care in Kansas City. She attributed any resistance to a long history of competition between KU Hospital and St. Luke’s.

“I think it has to do with the civil war,” she said. “I think it’s the history – the competition between the two hospitals and programs to get patients.”

No comment

The issue has been complicated by the fact that several major stakeholders are remaining mum on the negotiations.

Bill Hall, president of the Hall Family Foundation, didn’t return phone calls this week. He is thought to be a key player in gathering financial support from the Kansas City philanthropic community for affiliation agreements between KU and hospitals on the Missouri side of the border.

St. Luke’s, meanwhile, wouldn’t talk about a possible KU affiliation.

“We’re really not doing interviews about that right now,” said Kerry O’Connor, a spokeswoman for St. Luke’s. “We’re not providing any comment or disclosing any details to the public.”

Children’s Mercy Hospital spokesman Tom McCormally said his hospital is hoping for additional research programs with KU, and he said residency programs there may still be on the table.

“We’re a full partner in the Kansas City Life Sciences Institute,” he said, referring to an umbrella organization of 10 bioscience-related institutions in the city. “The bigger picture has centered on the adult hospitals. We’ve been sitting back and letting some of that play out.”

Topeka involvement

The cloudiness surrounding the issue has bothered some legislators, who will be seeking answers during Monday’s hearing of the Legislative Budget Committee.

“I just want to be certain that we understand that whatever we do is best for the people of Kansas,” said Sen. Jim Barone, of Frontenac, the ranking Democrat on the Senate Budget Committee. “If it’s good for the Kansas City metro area and all of Kansas, that’s great.”

Barone said he also wanted to make sure the state was clear about any philanthropic incentives to build affiliations across state lines.

“I’m always cautious when you look at contributions that come with strings,” he said.

Some legislators have worried that Kansas taxpayer money will be benefiting Missouri institutions. Atkinson said, if anything, Missouri hospitals would be paying KU for residency services, and Missouri foundations would be donating to the university.

Morris, the Senate president and Republican from Hugoton, said he didn’t want to see any proposal that hurt KU Hospital. But he also said the Legislature shouldn’t play anything more than an oversight role.

“We don’t want to be in the business of micromanaging,” he said. “But since we are talking about public funds, it is appropriate for the Legislature and regents to be involved in a positive way.”

Legislators aren’t the only ones hoping for more transparency in the process. Steve Roling, CEO of the Kansas City Health Care Foundation, an advocacy group for the poor and uninsured, said he hopes low-income health care is a key factor in negotiations, and that they’re not completely driven by research issues.

“The interesting thing about this is it’s being done very quietly,” Roling said. “There’s no public meetings or trying to get public input. It’s pretty hush-hush.”

No unanimity

KU Chancellor Robert Hemenway, who will be a presenter at Monday’s hearing, said he thinks many are jumping to conclusions when they hear about the negotiations.

“Absolutely nothing has been decided or resolved,” Hemenway said. “These are just exploratory discussions. Some people would prefer those discussions didn’t go on, but what they are are people just talking about the ways you could deliver even better health care to people.”

Hemenway said he thinks forming additional alliances will help KU have a “nationally recognized, world-class” medical center, and he thinks it can be done without harming KU Hospital. He cited a report by national education leaders, “Time to Get it Right: A Strategy for Higher Education in Kansas City,” which urged greater cooperation among institutions.

“The goal here is to provide the best possible care – that’s the goal of the hospital, the School of Medicine, and the goal of all the physicians involved,” Hemenway said. “We don’t always get unanimity on how to do that.”