Dr. William M. Crist

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The UA's vice president for health affairs says he's going to do what he can to reduce taxpayer costs at UPH Hospital, but that it may not be possible.

"If you look at the actual patient-care cost versus payment received from third-party payers, on average we lose money in each case," Dr. William M. Crist said in an interview last week. "Thus, I don't see a formula at this time that predicts costs are going to go down."

He stressed that UPH has an unusually high volume of underinsured and uninsured patients.

"Therefore there is a cost that can't be recovered," he said. "We can't begin to break even like most hospitals."

Crist oversees UA's partnership with University Medical Center, University Physicians Healthcare and UPH Hospital, among other responsibilities.

UPH Hospital has been in the news recently for revealing it will need a minimum ongoing subsidy of $25 million a year or more from taxpayers to continue to operate the former county hospital at Kino.

UPH has lost far more money than it expected since taking over the hospital in 2004 — $33 million over the last four years after the county's financial participation, and a projected loss of just under $5 million for this year after county payments of nearly $25 million — as it significantly increased the number of patients it treats and added doctors and specialty clinics to the hospital.

The existing agreement, signed in 2004 with the county, calls for a $127 million subsidy made in declining payments over a 10-year period, at the end of which UPH is supposed to be self-sustaining.

Long-term county support will likely be a major issue for Crist to tackle, after taking the UA post late last year.

So far, the county has paid nearly $110 million of the total subsidy, and like everyone else has budget constraints.

"We want the whole system to be successful and that is the challenge. Unfortunately that challenge is going to get greater," Pima County Administrator Chuck Huckelberry said.

"We have some concerns over the fluctuating cost and we will certainly continue to work to see what we can do," he said. "We want them to be successful."

Here's more of what Crist has to say about the issue:

Q: Do you foresee a day when UPH Hospital is not going to be asking for so much money from the county?

A: That's a frequent question and I think the answer is that all of us need to continue to do due diligence about what is the appropriate cost associated with managing a county hospital. Our shared purpose with the county at Kino is that we … believe that outstanding health care should be provided to every citizen of Pima County who needs it. Regardless of their ability to pay, health care is a basic right.

What we're doing — the medical school together with the county executives and UPH — is we're going to visit at least one other major county hospital that's very well established and see every detail of how they do it, what the cost is and how to minimize the cost to the taxpayers. We're going to look at how to do it best.

We're planning to visit Parkland (Parkland Health & Hospital System) in Dallas. … The fact that they are getting a $400 million subsidy from their county, still, after being one of the nation's best systems for many years, tells me there is a cost that likely can't be recovered.

Thus, it seems likely the county taxpayers will have to continue to contribute to covering a part of the cost in order for the hospital to remain healthy.

Q: Are you getting the patient volume at UPH Hospital to make it worthwhile?

A: Volume is going up dramatically. We're going to be needing to do new buildings on the campus very soon, and in fact some are in the very early stages of planning, because we are exceeding capacity. We cannot get patients into the inpatient service area frequently enough because we do not have the bed space.

There's a common misconception that the hospital is empty. It's dramatically different from that. Often you can't get a bed, and the emergency room is nearly as high as the volume as the ER at University Medical Center — more than 40,000 visits a year. …

If you don't have a hospital like UPH or UMC that's willing to take on more indigent care, those patients simply don't get cared for in our system.