The Kansas University Medical Center’s plan to strike up a new relationship with a Missouri hospital has brought about finger-pointing, legislative drama and hard feelings from those at KUMC’s longtime partner hospital, Kansas University Hospital.

But amid the controversy, people on both sides of the debate are steadily working through the details of how KUMC will relate in the future to both KU Hospital and its intended new partner, St. Luke’s in Kansas City, Mo.

The Journal-World talked in recent days with KUMC Executive Vice Chancellor and medical school Dean Barbara Atkinson, who supports the partnership with St. Luke’s, as well as outgoing KU Hospital CEO Irene Cumming, who has opposed it. These conversations were focused on getting down to details of what the deal means for medical education and research in Kansas.

Here are some of the key issues:

Q: What’s the benefit?

Atkinson says the main benefit of a KUMC-St. Luke’s affiliation is that it would offer a different experience for the more than 280 KU medical residents – doctors who have finished medical school but are pursuing additional specialty training. Already, she said, KU residents rotate to an academic medical center (KU Hospital) and to Veterans Affairs hospitals, but they don’t rotate to a community hospital with a private practice.

That, she said, is more like “how everybody who finishes our program is going to spend the rest of their life.” Only 10 percent of medical school graduates will go into academic medicine of the kind practiced at KU Hospital, she said.

Also, she said it opens the door for new collaborations by KUMC researchers who want to work with St. Luke’s staff members in “outcomes research,” the practice of studying what treatments worked and didn’t work for groups of patients.

Cumming said there doesn’t need to be a formal affiliation to do that kind of collaboration. And she said she doesn’t understand why that need suddenly has arisen to educate students in a new setting.

“I don’t think there’s a problem, necessarily, for students to be exposed to a community setting, but they’re learning,” Cumming said. “They need to be in a strong teaching environment. : Never have I heard a complaint that the education that our students and residents were receiving at our hospital was inadequate.”

What’s the bottom line for KUMC?

Atkinson said the answer is “more residents.” The expectation from medical center leaders is that St. Luke’s will eventually be paying for the education of 100 KU residents per year, which represents about $10 million annually.

“Those are going to be residents in a KU residency program,” Atkinson said.

Cumming, however, questions where all those students will come from, especially given that KU Hospital also is negotiating a plan with the medical center to add 100 residents of its own in the next decade.

“There probably aren’t enough people to apply to those residencies for what’s being proposed” by St. Luke’s, she said. “Will we, therefore, be decreasing the quality of the resident pool that we train?”

What about the $150 million pledged by donors in Kansas City?

In addition to the added residents, a group of Kansas City business and community leaders have pledged to contribute $150 million to KU’s medical school in coming years, but only on the condition that the St. Luke’s deal goes through.

Cumming is skeptical of that pledge.

“Where is the money? No one has shown us the money,” she said.

Medical center leaders say that money could be used for “unrestricted mission support”- in other words, flexible, strategic purposes – and that KU Hospital hasn’t been contributing enough of that type of funding to the medical school in recent years.

“KU Hospital’s investment in unrestricted mission support has been historically very, very low. Last year it was $1.5 million,” said Amy Jordan Wooden, a medical center spokeswoman. “When you look at a community investment of $150 million – a hundred times that – that’s something you have to look long and hard at. : I think Irene’s comment of ‘Show us the money,’ we might say the same to her.”

What’s KU Hospital doing to contribute more to the medical school?

In documents being negotiated behind closed doors, KU Hospital is working on a plan to increase its total support of the medical school by about $13.5 million next year, from roughly $30 million to $43.5 million.

How would a St. Luke’s partnership benefit KU Hospital?

Atkinson said that resources put into the medical school from the St. Luke’s affiliation will help recruit new top-flight faculty to KU, attract better students and ultimately make KU Hospital stronger.

Cumming, who is departing this summer to become the head of an Illinois-based consortium of academic medical centers, said she doesn’t see a benefit for KU Hospital.

“St. Luke’s Hospital is a direct competitor to KU Hospital. Any time you’re giving leverage to your competition, it certainly puts any organization like ours at risk,” she said.

She said her concern about a St. Luke’s deal is that “we will not be able to maintain the quality of the residency program or the quality of faculty that we have today.”

Another concern is that if top KU Hospital programs begin migrating to St. Luke’s, it could leave KU Hospital to assume a greater share of paying for the “uncompensated care” in Kansas City – care for people who can’t pay the bill.

Atkinson pointed out that KU already has affiliations with two major Wichita hospitals, Wesley Medical Center and Via Christi Health System, that are competitors.

Will the deal pave the way for KU faculty to leave KU Hospital for St. Luke’s – or not?

Jordan Wooden, the KUMC spokeswoman, said it’s a myth that KU faculty members now working at KU Hospital will be able to transfer their positions and programs to St. Luke’s.

“If you are a St. Luke’s physician who’s engaged in the education of residents, you are eligible for a nontenured faculty position” with KU, she said. “Physicians at St. Luke’s are not eligible for tenured faculty positions like what we have here.”

Also, a clause in the documents being prepared to shape the relationship between KUMC and KU Hospital says that no department heads will move to St. Luke’s.

But KU Hospital leaders say that doesn’t resolve their concerns.

“The problem is not necessarily that faculty would defect to St. Luke’s, but that physicians already at St. Luke’s or recruited in from the outside would be able to get KU academic credentials, and that KU programs could move there, with or without movement of faculty,” KU Hospital spokesman Dennis McCulloch wrote in an e-mail.

Where does Cumming’s successor fit in?

Bob Page, who has served as one of Cumming’s top lieutenants in recent years, “supports the positions taken” by Cumming, McCulloch said.

How would an affiliation with St. Luke’s help KU’s chances of getting an elite cancer center designation? Could the same goals be met as well or better by affiliating with one or more other hospitals instead of St. Luke’s?

Atkinson said KU does plan to affiliate with additional area hospitals, not just with St. Luke’s, through the Midwest Cancer Alliance, a planned network of doctors and hospitals statewide.

But Atkinson said forging the St. Luke’s relationship would help KU tap into a large piece of the market for cancer patients that St. Luke’s now holds, in affiliation with the Kansas City Cancer Center. KU intends to use that patient base to expand its clinical research trials.

“The issue with St. Luke’s is that they’re a very strong cancer hospital now,” Atkinson said.

Should KU pursue any kind of affiliation with St. Luke’s?

A small number of KU medical residents already rotate to St. Luke’s in specialties of ear, nose and throat medicine, rehabilitation medicine and plastic surgery.

“Those are essential experiences for the residents in those three programs right now,” Atkinson said.

But Cumming said that what’s being planned “far exceeds what we have been doing before, and the risk is there won’t be the number of people applying to residencies.”

How could an affiliation affect the supply of doctors that KUMC provides for towns across Kansas?

Atkinson said “it will certainly help,” given the additional residents to be added by St. Luke’s.

KUMC spokeswoman Jordan Wooden said: “I think there’s been a big misconception that somehow residents are St. Luke’s residents or that residents are KU Hospital residents. : It is KU that houses the education of those young physicians.”

Cumming said KU could easily expand the number of doctors it trains by building on the affiliations it already has with the two Wichita hospitals.

Is this a deliberate effort to cross the state line to build a life sciences connection?

“It is a deliberate effort to build the life sciences,” Atkinson said. “It does so happen to cross State Line Road, and that may create more issues than if it didn’t. It’s because they’re a major community hospital that is engaged in research. St. Luke’s is just being tackled first because quite honestly we knew that would be the one that would require the most energy.”