UPMC Braddock usage rate disputed

It indicates hospital wasn't underutilized

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University of Pittsburgh Medical Center officials say they decided to close UPMC Braddock because it was underutilized, not because it was losing money.

But state health department reports on hospital utilization -- annual reports based on numbers provided by UPMC -- show that UPMC Braddock's occupancy rate in 2007-08 was 72.4 percent, higher than six other Allegheny County hospitals, including UPMC Mercy, West Penn, Heritage Valley in Sewickley and Ohio Valley.

In fact, reports show that since 2000 the Braddock facility never has averaged below 69 percent occupancy and was slightly above the countywide average during that span.

UPMC spokesman Paul Wood said those numbers don't tell the real story, because they include UPMC Braddock's behavioral health beds used for the drug and alcohol, sober living and detoxification programs.

In fiscal 2009, nearly 1,400 people were admitted to that program's acute psychiatric program at least once, 951 were admitted for medical detoxification and 497 were in the Living Sober rehabilitation program. Less than 6 percent of those admitted were from the Braddock area.

"General [medical/surgical] utilization by area residents determines the success or failure of any community hospital," Mr. Wood said. "Behavioral health beds were not part of the calculus since they're managed centrally out of [Western Psychiatric Institute and Clinic], not by UPMC Braddock, and they're mostly being reallocated to other hospitals."

He said the daily census for use of medical/surgical beds has declined from 64 in fiscal 2007 to 51 in fiscal 2009 and dropped further to 44 in the first quarter of this fiscal year. The hospital has 101 licensed medical/surgical beds.

He also reiterated that four of five Braddock residents choose to get their care at facilities other than UPMC Braddock. "The 20.8 percent market share ... is the lowest of any hospital in the system."

That figure is being questioned, too.

UPMC calculates there are 45,000 people living in the Braddock service area. In the first quarter of fiscal 2009, it says, about 2,000 Braddock area residents required inpatient medical/surgical care but only about 400 chose to go to UPMC Braddock.

Braddock Mayor John Fetterman said UPMC would have to count communities such as Forest Hills and Edgewood to reach the 45,000-service area population figure -- communities whose residents likely wouldn't go to Braddock anyway.

The mayor also said that it's not always a matter of choosing to bypass UPMC Braddock. If a Braddock resident needs open heart surgery, or if a family is having a baby, those cases would have to go elsewhere because those services aren't offered at the Braddock hospital.

Besides, he added, "Who chooses which hospital you go to? They're making it sound like you're choosing between McDonald's and Wendy's, but the patient doesn't choose which hospital they go to. The doctor makes an appointment and you go where they tell you."

Braddock Council President Jesse Brown, 74, said he's noticed that he's being more frequently referred to other hospitals for his prostate cancer and heart condition treatments.

"Even if you're walking in off the street and they've admitted me, they've kept me for two or three days then shipped me out [to another hospital]. If you do that, then definitely you're not going to have enough people."

The two Braddock leaders' comments, coming two weeks after UPMC announced that it would close the Braddock facility Jan. 31, show that suspicions still linger -- and in some instances have grown -- that the decision had less to do with use and more to do with UPMC's plans to build a hospital in Monroeville.

Despite its proximity to competitor West Penn Hospital's Forbes campus, the Monroeville facility likely will fare better financially than UPMC Braddock because it will serve a more affluent demographic.

The Braddock facility has seen negative operating margins -- the operating revenue left after operating expenses are paid -- exceeding 5 percent during the three years ending June 2008. In fiscal 2008, the margin was negative 7.11 percent with patient care revenue of $57 million, compared with $107 million at UPMC McKeesport.

"They're saying it's not a money issue. I say it is," said Mr. Brown. "They're a non-profit, they're making money, but instead of putting that money back into the community where you have low-income people, they're moving into Shadyside and Monroeville and the city of Pittsburgh. They're moving into the affluent suburbs."

Mr. Fetterman particularly resents the argument that Braddock is losing its hospital because residents didn't use it. "Just be honest and say, 'We had to pick a winner and we had to pick a loser, and Braddock was the name we pulled' instead of trying to blame it on us."

Mr. Fetterman said he defended UPMC last year at a public protest of the health system's decision to close the House of Hope program for chemically-dependent pregnant women and mothers of newborns -- a decision later reversed. He realizes and appreciates that UPMC continued operating the Braddock facility at a financial loss year after year.

Now he thinks the House of Hope "was the canary in the coal mine. They were just freeing themselves up. Once Monroeville became their plan for the eastern suburbs, then it just became a matter of time before Braddock had to go."

He was part of the contingent, along with Congressman Mike Doyle and County Executive Dan Onorato, who visited UPMC President and CEO Jeffrey Romoff at his office Oct. 19 to see if an alternative to closure was possible. He believes now that UPMC was not interested in finding a way to keep the Braddock facility open.

"These same people in a room could have found a way to make it work, but they [UPMC officials] don't want to make it work," he said. "It just seems that no matter what was presented, they spun and contorted it. There was a script they needed to stick to and, no matter what you presented, that's what they came back to."

Steve Twedt can be reached at stwedt@post-gazette.com or 412-263-1963.


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