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(First of two parts. Editor's Note: Correction appended May 23, 2011.)

McKeesport's hospital is here to stay.

That's the message that University of Pittsburgh Medical Center officials are trying to deliver in the face of rumors that the 213-bed facility is to be downsized or closed. In fact, UPMC McKeesport has several opportunities to expand its service area and market penetration, says Cindy Dorundo, the hospital's chief executive officer.

"We have many, many dedicated and talented professionals here at UPMC McKeesport," she says. "We have some managers here who have been here 30 years, but we also have new sets of eyes looking at things. I think we have a very good balance of vision and passion."

. . .

The hospital's more than 1,000 employees --- 72 percent of whom live in the McKeesport area --- are "actively focused" on ways to cut costs "and still expand our core services," Dorundo says.

Indeed, over the past two years, UPMC McKeesport has gone from a $2.9 million annual deficit to a $4.5 million surplus. Hospital admissions are up 20 percent, emergency room visits are up 18 percent, and $2 million was invested in the hospital's infrastructure in 2010 --- with another $8 million to be invested this year.

But at least some of those gains are due to the closure of UPMC Braddock, another hospital in a struggling Mon Valley community. UPMC Braddock's January 2010 closure came as the state was preparing to invest $6 million to upgrade the facility.

. . .

And UPMC Braddock isn't the only local hospital to have closed. Over the past five years, other Western Pennsylvania milltowns such as Aliquippa, Brownsville and Jeannette have lost community hospitals. Last year, UPMC's rival, West Penn Allegheny Health System, downsized its one-time flagship West Penn Hospital and turned the former Suburban General Hospital into an outpatient and long-term-care facility.

With UPMC preparing to open a new 156-bed* hospital in Monroeville --- only an 18-minute drive from the city on Route 48 --- rumors have continued to swirl about UPMC McKeesport's future.

Monroeville's UPMC East, scheduled for completion in 2012, could siphon off at least some UPMC McKeesport patients who would rather travel to a new facility in an upscale shopping area than to an existing facility in a struggling inner-city neighborhood.

. . .

UPMC McKeesport is not like UPMC Braddock, says Dorundo, who would know. She previously served as CEO of UPMC Braddock and for a brief time oversaw both the McKeesport and Braddock hospitals.

The McKeesport hospital serves an area almost three times larger than UPMC Braddock, she says. And a much higher percentage of residents in UPMC McKeesport's service area --- which stretches roughly from Route 51 to the Pennsylvania Turnpike, and south to the Washington County line --- use the hospital.

Indeed, according to Pennsylvania Department of Health statistics, in 2008-09, although UPMC McKeesport had only about 50 more beds than UPMC Braddock, it served nearly three times as many patients and had an occupancy rate of 77 percent, versus 69 percent at Braddock.

In addition, UPMC McKeesport's CT and MRI scanners were each used almost twice as much as UPMC Braddock's, state Health Department statistics indicate. But UPMC Braddock's overhead wasn't proportionately smaller --- it employed 652 people before its closure.

. . .

UPMC McKeesport is also a teaching hospital for students from the University of Pittsburgh School of Medicine and the Lake Erie College of Osteopathic Medicine, Dorundo says, and offers cardiology and cancer care that Braddock never offered.

"What we'd like to see is UPMC McKeesport increasing its footprint," she says. Only 4 percent of the hospital's admissions are from the North Huntingdon area and only 8 percent are coming from north of Route 30.

With this year's closure of Excela Jeannette Hospital in Westmoreland County, UPMC McKeesport believes it "can secure or even grow that" market share, Dorundo says. "There is real opportunity in terms of growth, not replacement of market share."

. . .

As for UPMC East, it's designed to serve patients from Monroeville, Churchill and other eastern Allegheny County communities who aren't utilizing UPMC McKeesport anyway, she says. At least 100 patients daily from the Monroeville area are driving to UPMC's Oakland and Shadyside hospitals, Dorundo says.

"We see UPMC East as being a partner, not a competitor," she says.

Still, UPMC McKeesport faces challenges the Monroeville facility won't face --- among them, a perception that McKeesport has become "unsafe" for visitors and that UPMC McKeesport isn't as good as other hospitals in the UPMC system.

. . .

What's more, UPMC McKeesport serves a patient base that's overwhelmingly poor and elderly. According to the Pennsylvania Health Care Cost Containment Council, UPMC McKeesport serves the highest percentage of charity cases of any hospital in a seven-county region --- about 5 percent of care provided by the hospital isn't paid for, or about twice the regional average.

More than 59 percent of UPMC McKeesport's revenue comes from Medicare patients -- third-highest in the region, after only Jefferson Regional near Clairton and Alle-Kiski Medical Center near Tarentum. About 10 percent of UPMC McKeesport's patient revenue comes from people receiving Medicaid, which is near the regional average, but still 10th-highest among 27 hospitals.

(The hospitals treating the lowest percentage of Medicaid patients include St. Clair Memorial in Mt. Lebanon, UPMC St. Margaret near Fox Chapel, and UPMC Passavant in McCandless and Cranberry --- all wealthier suburbs.)

. . .

There's little that UPMC McKeesport can do about the demographics of the Mon Valley, Dorundo says, and with the federal government cutting Medicaid reimbursements by 12 percent, the difficulty of serving a poor, elderly population will become more acute.

"We know what the reimbursement structure is," she says. "There's no question that it's a challenge."

Partners "help mitigate the economic challenges related to the population," Dorundo says. Those partners include the McKeesport Hospital Foundation, which has supported capital improvements at UPMC McKeesport and community outreach programs since the formerly independent hospital merged with the University of Pittsburgh Medical Center in April 1998.

But the perception of the quality of care at UPMC McKeesport doesn't match the reality, Dorundo says, arguing that by most standards, the hospital does quite well.

. . .

In fact, UPMC McKeesport meets or exceeds state and national averages on most benchmarks for surgical and heart attack care, according to the U.S. Department of Health and Human Services. The department says the hospital is at or near 100 percent in measurements that examine whether patients received the right treatments at the right time.

"Many of the best hospitals in the country are not located in the best parts of cities," Dorundo says. "Out of several hundred hospitals across the state, we have the third-highest compliance rate with the protocols of care."

More proof of the hospital's quality, she says, comes in the success of residents who have trained there. In recent years, "100 percent" of medical students who trained at UPMC McKeesport have passed their state boards.

. . .

Part 2: Addressing the challenges

*Correction, Not Perfection: This article originally reported that the new UPMC East hospital in Monroeville would have 118 beds. According to UPMC spokeswoman Susan Manko, UPMC East as currently planned will have 156 beds. (May 23, 2011)

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