HJNO May/Jun 2024

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAY / JUN 2024 15 how we got here. I understand back in the Governor Jindal days, they were removing the public hospitals and trying to move to private; there's a handful that still remain public-private. I think Our Lady of the Lake has that same sort of arrangement. UMC is unique because it is very much centered around the academic medical cen- ter. Just take learners for a moment: We are partners with the state of Louisiana, with LSU, and Tulane. There are nearly 3,700 individuals who rotate through UMC a year. On any given day, there are 200 learners. That could be medical residents and fel- lows or nursing students, medical students, radiology techs, respiratory students, den- tal students or residents, etc. It is by far the largest single place in the state of Louisiana that trains the next generation of healthcare professionals. That's part of our responsibility as a partner with the state of Louisiana: We're a safety net hospital, which means we see all patients regardless of their ability to pay. So, if the Louisiana legislature chooses not to invest in the public-private partnership, well that's damaging to us. They've been very generous and worked with us in find- ing methodologies to support UMC and any similar hospitals across the state. But that safety net piece is always a challenge since we see all patients. We're also the Level I trauma center for South Louisiana, so we have a responsibil- ity to the state of Louisiana, if not the Gulf Coast, to build programs since we're the only place in the state that you can get that care. An example is for burns — you have to go to Houston or Tampa to find a verified burn center otherwise. When you think of all the oil rigs that are in the Gulf and the other burns that happen across the state, they end up at UMC, and we provide that care. I mentioned behavioral health earlier. We're the only crisis center for those who are struggling with behavior health issues. If you haven’t toured our 61-inpatient-bed unit, it's something you have to see. The progression over the decades of how we treat our most vulnerable [population] is amazing at UMC. It is a beautiful hospital. It's a billion-dollar hospital. I mean, you want to compare it to Houston with Ben Taub and LBJ. Wow! UMC is infinitely bet- ter than those hospitals from a brick-and- mortar perspective. Editor You speak about the bricks and mortar. UMC rose from the floodwaters of Katrina. How prepared is UMC for a Category 5 hurricane and all the unexpected twists that it can do to a city below sea level? Nickens UMC is a fortress and a beast in the way it's been built. We went through Hurricane Ida, and if you look at the generators, there was absolutely no stutter step in coverage from the generators. There was no damage to any of the windows. It stood and powered through with no issues, if that's any sort of indicator. UMC was designed in the wake of Hur- ricane Katrina based on the many lessons learned from enduring such a storm. The campus’s first floor is above the 1000-year flood plain. All essential utilities and hospital functions are placed above the first floor. If that floor floods, UMC can still function as an island upon itself. The emergency room is on the second floor with an elevated ER deck for access. The building roof, facades, and glass are rated between 130-150 mph winds for uplift and missile impact. UMC has enough emergency generator and fuel capacity to sustain the entire campus for weeks after a large storm. We talk about Spirit of Charity. I've spent some time over the last few months really studying Charity Hospital. We talk about our mission and culture, and what started at Charity in 1736 continues at UMC today. And we've added an expectation that in every sit- uation we're going to choose excellence. We learned from the history of Charity Hospital that regardless of what was going on — a fire, a depression, a hurricane — people showed up. They came to work, and they took care of NewOrleans. Unfortunately, that building was not able to continue. But now at UMC, we're adding the expectation for our team to “choose excellence” with all decisions, and that includes the rigor of the hospital in any kind of hurricane or any kind of threat. I feel very confident fromwhat I've been told, and in my own exploration around the campus, that University Medical Center will stand strong and be prepared for whatever New Orleans needs. Editor Speaking of Charity, I understand Charity Hospital didn't charge patients until the 1960s. What a different time. Nickens Yeah, the cost of healthcare has increased since the 1960s. Editor Do you think it should be 20% of the gross domestic product (GDP)? Nickens With the cost of healthcare, you are now starting to get into the intellectual and philosophical side of the industry. I think the best way to measure the value of healthcare is quality divided by cost. You can argue what percent of GDP that should be. It is an economic engine. There are legitimate costs that are associated with systems when you're going to offer cutting- edge research. You're going to try to create new methodologies and treatments and therapies for areas of focus like cancer. If you look at cancer 20 or 30 years ago, 70 to 80% of kids who were diagnosed with cancer died. Today, 70 to 80% live; that is a radical change. It’s the same with HIV over the last 30 years. The treatment plans that exist are radical compared to the kinds of investments being done. But I think where you get the balancing measure is quality divided by cost. We have to be good stewards of our cost structure; otherwise, it's just not sustainable. I think that's some of what you're seeing across healthcare post-COVID — the reinvention of models of care and how we invest. It's one of the reasons why we're expand- ing to dual roles at LCMC Health, because then you can reduce some of the cost struc- ture. For example, I am serving as both CEO