University Times

Of all the changes that have occurred in the health care industry over the past decade, none is more evident from the patient's point of view than the shifting of many services from hospital stays to out-patient care.

Driven by the refusal of insurance companies to pay for hospital stays, diagnostic testing and other procedures that once involved a few days in a hospital now are done in the morning and the patient is sent home for lunch.

To successfully compete in such an atmosphere, health care providers have found they need to offer their services in convenient locations. Patients and their families today generally are unwilling to travel more than a few miles to undergo a procedure or visit a specialist.

Seeing the handwriting on the wall, the University of Pittsburgh Medical Center (UPMC) a few years ago launched an expansion program that has carried it beyond Presbyterian University Hospital into other areas of Oakland, the city, its suburbs and surrounding counties.

UPMC President Jeffrey Romoff has estimated that the expansion will eventually cost the medical center $30 million – $50 million, excluding physician acquisitions and operating costs.

"What UPMC has been striving to do is put facilities out in the community, taking the doctors to the patients if you will," said Joseph Lipinski, medical director for the satellite clinics. "It's almost like going back to the days of the house call, to put doctors in proximity to where patients live." "Clearly, it is important from an institutional perspective to make certain that we have visibility at various sites over a broad geographic area," added Tony Detre, satellite clinic program director. "We think we have an excellent product and we want people to be able to conveniently access it. That's been the main drive behind moving out into these areas." To date, UPMC has established clinics in Squirrel Hill, Greenfield, Hazelwood, Downtown, the University Center at the Holiday Inn in Oakland, Greensburg, Edgewood, Greater Pittsburgh International Airport and most recently Bethel Park. When completed, the Bethel Park clinic will contain 80,000 square feet of medical space and 10,000 square feet of storage, about the same as Falk Clinic.

UPMC also recently closed a deal on property near the Greensburg/Mt. Pleasant exit of Route 30 about two miles from Pitt's Greensburg campus, where it plans to build a 12,000-square -foot clinic. Plans for next year also call for the opening of clinics in Monroeville, Moon Township and Washington, Pa.

Detre said UPMC decided to construct a second Greensburg clinic because of the success of the small, 7,200-square-foot clinic it opened along Route 30 west of the city last year. "The new facility is a joint venture with Latrobe Hospital," Detre said. "It will have primary care/internal medicine doctors from Latrobe and specialists from UPMC and Latrobe." The other Greensburg clinic is a sole venture of UPMC. It employs cardiologists from Latrobe Hospital, but all other specialists are affiliated with UPMC, according to Lipinski.

Although the satellite clinics are UPMC-driven projects and owned by the medical center, Detre said that UPMC considers them to be partnerships with its affiliate hospitals. The Bethel Park clinic, for instance, will have one floor occupied by Children's Hospital and another by Magee-Womens Hospital. Special services available at each clinic vary according to the clinic's size and location. To keep costs under control, clinics such as those at Squirrel Hill, Greenfield, Hazelwood and Edgewood have limited testing facilities and availability of specialists because of their proximity to Presbyterian University Hospital.

On the other hand, the Bethel Park clinic will offer a wide array of specialists from cardiologists to rheumatologists to orthopedists to pediatricians. "All of the UPMC specialists want to go out there because we have such a strong market share," said Detre. "We're also going to have physical and occupational therapy there." To serve the business community Downtown, UPMC's newly remodeled clinic on the fourth and fifth floors of the former Gimbel's Building will contain a wellness center when it reopens in mid October. The center will be affiliated with the Duquesne Club.

UPMC's airport facility is the smallest, meant to handle physicals for airline personnel and urgent care for people passing through the airport. All of the clinics have X-ray rooms and most have testing laboratories.

While the types of specialists vary from clinic to clinic, all of the satellites have family practice and internal medicine physicians on their staffs. Internal medicine physicians provide care for individuals 14 years of age and older, and handle everything from preventive care to critical care, including gynecological care.

Lipinski and Detre said it is difficult to estimate how many people are employed by the clinics or their effects on staffing in Oakland because many individuals work at more than one clinic, as well as in Oakland. Including staff from affiliate hospitals, though, Lipinski estimates that the satellite clinics employ about 500 people. "What the hospitals did in Oakland had to change," Detre added. "Service and access for patients is the key now. We need to provide the services in areas that are convenient for patients. So, we're going to those communities where the need exists to service our patients and to service patients in those areas who currently don't have proper access to facilities." Information on UPMC satellite clinics, services and doctors is available by calling 647-UPMC.

–Mike Sajna