Chapter 05: Establishing the First Satellite Center: “A Great Business and Clinical Story”
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Description
Ms. Hay notes that the story of the Radiation Oncology Center in Bellaire, Texas, is ‘a great business and clinical story’ that led to the creation of the entire satellite system.
She tells the story of setting up a health center in Bellaire, Texas. She explains why this was bold and controversial move. She talks about the negotiations with General Electric (which owned the note on the Center) and describes how the Center was opened, with immediate positive responses from patients. She describes the involvement of the Physicians’ Network.
Next, Ms. Hay explains that the Bellaire site was the beginning of the entire satellite system and the expansion that was part of John Mendelsohn’s [Oral History Interview] vision for the institution.
Ms. Hays talks about the selection of partners and factors that lead to the success of the satellite locations, including MD Anderson’s willingness to terminate ineffective partnerships.
She reviews the growth of the use of satellite centers and stresses how important they are for the future of MD Anderson.
Identifier
HayAC_01_20150204_C05
Publication Date
2-4-2015
City
Houston, Texas
Interview Session
Amy Carpenter Hay, Oral History Interview, February 04, 2015
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Building/Transforming the Institution; Institutional Processes; MD Anderson History; Institutional Mission and Values; Growth and/or Change; Patients, Treatment, Survivors; Character, Values, Beliefs, Talents; The MD Anderson Brand, Reputation; Beyond the Institution; MD Anderson in the Future; Discovery and Success; The Institution and Finances
Transcript
Tacey Ann Rosolowski, PhD:
This is kind of leading to some broader issues. And just to pick up a detail, the position that—it—am I correct that the position that Dr. Cox offered to you was director of Radiation Oncology—
Amy Carpenter Hay:
Yes.
Tacey Ann Rosolowski, PhD:
—in 2001? Okay. And you held that from 2001 to 2005 and developing the pro—the—kind of financial infrastructure for the Proton Therapy Center was one of those missions.
Amy Carpenter Hay:
Mm-hmm.
Tacey Ann Rosolowski, PhD:
Now, you mentioned the regional resource. Another thing you were doing was developing the satellites.
Amy Carpenter Hay:
Yes, yes.
Tacey Ann Rosolowski, PhD:
So tell me—tell me about that process, too. I’m sure we’ll come back—
Amy Carpenter Hay:
Yes.
Tacey Ann Rosolowski, PhD:
—to proton therapy.
Amy Carpenter Hay:
No, I’m sure you will. Yes, because they’re—they were happening simultaneously, but they were very different. So—and I still think that the story of how we got to where we are today in the regional network is fascinating. One of these days, it’s just a—it’s a great, great business and clinical story on how we got there, and it all starts with Bellaire. So, going back, Dr. Cox said, “I’m very interested in this property. It’s kind of rundown. It’s being operated by a radiation oncologist that no one’s really happy about.
Tacey Ann Rosolowski, PhD:
What was it—what’s the name of the service that was located there?
Amy Carpenter Hay:
It was a radiation oncology center.
Tacey Ann Rosolowski, PhD:
Okay.
Amy Carpenter Hay:
I don’t know the exact name, but you can fill in the detail. And so, he asked me to go take a look at it. So, I went over there and took a look at it, and he was right. It was a dump. [laughter] It was—it was approximately ten miles away from the Texas Medical Center [TCM], so it was literally down the street. And it needed a lot of work, but I saw it as a huge opportunity. So, I got very involved, and started writing business plans. What could we do here? Could we take it over? Could we lease it? Could we buy it?
Tacey Ann Rosolowski, PhD:
What was it that you saw? What got you so excited about this property?
Amy Carpenter Hay:
I think it was the idea of extending MD Anderson out of the Texas Medical Center. So, with my background a patient advocate, and even as a PSC, MD Anderson is a—often a daunting place for patients and families. And radiation oncology—as you know, most of the time these treatments are four to six weeks. That mean that these patients have to come to the Texas Medical Center four to six weeks, every single day. That’s hard. That’s hard on anyone. And while we did the best we could—you know, we offer valet, and close, you know—it’s really a strain, you know? And a lot of these patients are very sick, so they need help. They can’t come on their own. The need loved ones to help them, and that’s a loved one coming into the Texas Medical Center every day. And so, to me, this was a—just a fantastic opportunity to see if we could build an environment. And starting with just radiation, in which the patients literally could drive up to the front door, get out of their car, walk in, get their treatment, and walk right back out. Not go through a maze, not get stuck in valet, not get stuck somewhere else, but a smaller environment. So I was very intrigued by that. You know, until that time, we really had not gone outside the Texas Medical Center. We had been very focused. And this was something new and different. And I think there’s a little bit of a personal storyline there in that, all along my career here, I’ve been intrigued and enchanted by the new and different. You know, what’s the—what is—what is new, you know? What can we do that’s different in how we deliver care, how we approach care, how we access patients—whatever the case may be. So, as luck would have it, this center was in such distress that the owner of it had defaulted on his payments. And GE [General Electric Capital] held the note to the center. So, got to talking to GE, and got to kind of understand. And they had no interest in owning a Proton Therapy Center. They didn’t want to own it. They just had that as the collateral for their note. So, they were very interested in a potential buyer in order to, quite frankly, get out of this. They didn’t want to own a center and they didn’t want to operate it. They had no business in that. So as the facility closed and GE took the note, they looked to us to take it from them, which was a great opportunity. It needed a lot of work. It needed patching and painting and new equipment. And oh, by the way, you had to find a doctor who is willing to go outside of the TMC, because we had been very TMC-focused. And you needed to find a physician who perhaps is not as academically inclined—so, someone that wants to treat patients most of their time. You know, is not interested in having a basic science lab. Not that the individual wouldn’t be involved in clinical trials, but it would need to be someone that wanted to be at that center. Because a lot of the value I saw was having an environment where a patient could come in the front door and it’s small enough that they could see their doctor every day. Doesn’t mean they’re seeing him in the clinic, but they would know that the doctor was there. You don’t get that on Main Campus. I wish we could. You know, you get seen every week by your doctor, and that’s fantastic. But it’s a big place. You come in and you get treated. Unless there’s a problem, you leave. This was a new take. This was one PSC; therapists that stayed on the same machine and were dedicated to that center; and a doctor that that was gonna find his or her home there. So, if you needed to see—and the first doctor we recruited was Dr. Elizabeth Bloom. She was perfect. She trained at MD Anderson. She would—did some military service and was ready to come back. But she did not have a basic science, academic bent. She wanted to treat patients. She wanted to be there every day. She wanted to say hi to patient X and know that his wife was sitting in the lobby and ask how their kids were. She wanted that type of environment, so we were able to draw her in. She joined us to open up this center. And that was right around Y2K [2000]. And the reason why that stands out is because here at MD Anderson, we all thought the world was going to come to an end. And surely all of our IT [information technology] would not work. So, we were—we were pushing everyone to get the center and operational before Y2K hit, just in case all of the IT systems just crashed. And, of course, as we all know, that was a non-event [laughter] and we were all just fine, and everything worked. So we opened up that center right around 2000. And really, immediately, had just an unbelievably positive patient-care response. One of the parts I did leave out—which I don’t want to, because I think it’s humorous—is, much like protons, in order to get this approved—meaning in order to purchase this distressed property from GE and to operate it as MD Anderson—we had to get it through the MD Anderson Physicians’ Network board. And the reason for that is, we were going to sit the property and the employment of this position in MDA PN, or the Physicians’ Network—the 501(c)(3). We went to the board three times, and every time went they would give me—and I was—I was still very young and enthusiastic and, perhaps, immature. They would give me a new, “This looks great, Amy, but we want to see this before we approve. We want to see the patients that you’re gonna—you’re gonna attract. We want to see the doctor you’re gonna hire. We want to see the financial pro forma.” And so, every time we’d go it would be one more ask. And on the third time, I had brought everything they could possibly want, and Dr. Cox was there with me. We had a whole team of people. There was no question they could ask. And my current boss, who around that time became a friend and mentor, finally said—and that’s Dan Fontaine—he finally said, “Everything division—everything we’ve asked the division they’ve given us. This is their third time here. This clearly makes sense.” But then, in—for those people that know Dan, this will not surprise them at all. But then he said, “Amy, this is a flea-bitten dog. So if you can go make this flea-bitten dog successful, then we will look at doing something else. But it’s a flea-bitten dog. But based on that, we approve.” And I always kid him about that, because that was the beginning of a huge infrastructure we now have around Houston. Had we not done that—had we not taken the flea-bitten dog and were able to risk a little bit, we wouldn’t be anywhere near to where we are today.
Tacey Ann Rosolowski, PhD:
Just to kind of dot that i, what did people perceive as the risks in doing this? It seems like not such a big risk—a little center, an outpost.
Tacey Ann Rosolowski, PhD:
At the time, MD Anderson was very self-contained. This was outside of our main walls. This was a little bit uncomfortable. How could we possibly control? This was a little different. This was the first time that we were actively hiring a physician, and her employment was with PN. It was not with PRS. It was a little different. Everything was a little different. There was a lot of concern about competing with Main Campus. Now, rationally, this is one [inaudible] accelerator. This is, at tops—at tops—thirty patients a day. But I think it was just the uncomfort of something new. It was the change. I’d like to think that people were concerned because they saw that this marked a shift. And being so introspective to maybe being fairly extra-spective. But I think a lot of it was just the change. We were very comfortable inside our own house. This was going next door. Now, we did it with a lot of belts and suspenders. It was ten minutes away, so what’s the worst thing that could happen? We get in our car and we’re ten minutes away. You know, we had a doctor we trained. All the staff was ours. The equipment was ours. Worst thing that happens patients don’t like it; we don’t get the volumes; we close it down. And, thankfully, that’s absolutely not what happened. But I think that was the angst. This was different. This was outside Main Campus. “Not sure we can do this. Not sure we should.”
Tacey Ann Rosolowski, PhD:
Now, you know, it just—it’s interesting, kind of, that this was opened about, you know, four years after John Mendelsohn came. And, you know, he brought a little bit different vision. You know, certainly, looking outward—I mean, looking for international patients, looking for international fundraising. Just a whole lot more looking outside the institution. And I’m wondering, you know, was that kind of part of the zeitgeist? You know, things are—things are—
Amy Carpenter Hay:
[inaudible]
Tacey Ann Rosolowski, PhD:
—shifting here.
Amy Carpenter Hay:
I think so. I think a lot of it was Mendelsohn’s approach, and you articulated it very well. He was—he was looking external, and it wasn’t just about development. He was looking external in research. He was looking external in talking to people. He came from, you know, external. And so, I think the tide was changing. And so, you know, even, even today—even with Dr. DePinho, that the tide changes, and that always provides a little bit of angst because—
Tacey Ann Rosolowski, PhD:
Right.
Amy Carpenter Hay:
—it’s the fear of the unknown. It’s the fear of the change.
Tacey Ann Rosolowski, PhD:
Right.
Amy Carpenter Hay:
I think that is a lot of the reason why there was some anxiety. But I also think it’s the reason why it was approved. And it was the reason why a lot of people, over time, got very committed to building externally to MD Anderson. So, the center—the center started operating, immediate patient and family positive feedback. They loved it. You know, I—early, and I was still in the division at the time—I literally would pull up every single new patient coming in the Division of Radiation Oncology by zip code. And if you lived in 77401, which was Bellaire, I called you. You got a call from Amy Hay, and Amy Hay said, “I see you’re on the schedule. That’s fantastic. Happy to keep you right where you are. But you may not know that we just opened a center in your neighborhood, and it’s being staffed by Dr. Liz Bloom, and she trained at MD Anderson. And if you’d like to be seen tomorrow, I can get you in tomorrow. But I’m happy to have you at Main Campus, too. I work for both sides.” So—and I would literally work the phone for the first couple of months to make sure that we had patient volume and it started to sustain itself over time. Now, that satellite, very quickly, got people’s appetites whet. They realized patients love this. Financially, it works very well. Not only does radiation oncology make a nice margin, but these centers don’t have the overhead that we have here on Main Campus. They don’t have the burden of the research that we require here. They don’t require it there. And so, it allowed me to start slowly organizing some plans to look for other opportunities in the Houston region. So, fairly quickly—about a year after we got Bellaire up and running well—we started looking at opportunities in the Woodlands with St. Luke’s, at the time. And also in Richmond, with Polly Ryon [Memorial Hospital]. And both of those facilities, over the next few years, opened with radiation oncology, and also started to include medical oncology, and pharmacy and lab to support it. And what we saw very quickly was that, as soon as you add medical oncology, your radiation volumes go up twenty-five percent. Oh, and by the way, now that we’ve added medical oncology, the patients are saying, “Well, can I get everything out here? Do I really have to go to Main Campus?” And so, we quickly started thinking through what were our next steps, and we started being a little bit more thoughtful in where we’re gonna go and who we’re gonna partner with. What that meant was that we—and years are passing during this time period—we ultimately grew our [phone vibrates]—I’m sorry. I apologize. Scared me to death.
Tacey Ann Rosolowski, PhD:
[laughs] I know, that scared me to death, too. It sounded almost like a—an emergency [inaudible].
Amy Carpenter Hay:
I know, I put it on—I put it on vibrate just in case. [laughter] We started expanding. We looked very carefully at our partners to make sure that they met our mission and really were good partners. And one of the things, actually, I’m most proud about is that we were not afraid to terminate relationships that didn’t meet our expectations. And that was a new thing for, I think, MD Anderson in business development. And we kept that up. Our commitment is to the doctors and to the clinical quality, and if you’re not committed to that and you’re our partner, then it’s probably not a good fit. So, over time, we, quite frankly, got out of our lease at Polly Ryon. And we looked for another partner in Sugarland, with St. Luke’s. And then, the years following, we partnered with, at the time, Christus, and built facilities with them in the Bay Area, and also in Katy. Today, all of those centers are fully functional. They have radiation oncology, medical oncology, pharmacy, lab, and surgery that goes out there. We very carefully orchestrated this, much like we did the Proton Center. And I think it’s an important point, in that our business model was to engage with a partner—so, in this case, St. Luke’s and Christus—and lease. So, we would give them a ten-year, long-term lease backed by the full, you know, credit of MD Anderson, University of Texas, which is a nice lease to have in your portfolio. And they would, in turn, build the building and equip the center. And so, we were doing all of this in a way that we were not extending our personal capital. We were letting our partner do it. But we were committing to a long-term lease, and we were providing all of the medical staff and the clinicians and support necessary. And that model worked very well for us until, you know, just recently, and some changes that we’re gonna be looking at. It worked very well. Over time—and this is where it’s hard to stay in chronological sequence—over time, these centers, as of FY [fiscal year] ’13—these centers had over 4,000 new analytic cases that were seen. As I often remind people, some of the largest academic centers in the US don’t see 4,000. We see 4,000 in our regional satellites. That’s an amazing number. We have sixty-eight faculty that work out there—so, doctors committed. We have over 400 clinical staff committed. And last year alone, we did sixty million dollars in margin. If you look at the overall patient margin of the institution, it was ninety last year. So, we are able to deliver the highest quality care in the regional setting, without the infrastructure that we have to have on Main Campus. And every dollar goes back into the mission, so that sixty million that we make out there on providing the best patient care goes right back into the research that we need to do here in the Texas Medical Center. And I think that’s kind of the beauty of the whole—the whole extension process. So the regional centers, I think, are an important component of our history and, quite frankly, an important part of our future. So, I guess I’ll pause for a moment there.
Tacey Ann Rosolowski, PhD:
Sure, do you want me to pause the recorder?
Amy Carpenter Hay:
Yeah. I’m trying to decide where to go next.
Tacey Ann Rosolowski, PhD:
Pausing at quarter after 2:00. [The recorder is paused]
Tacey Ann Rosolowski, PhD:
Well let’s—do you want to resume again?
Amy Carpenter Hay:
Sure.
Recommended Citation
Hay, Amy Carpenter and Rosolowski, Tacey A. PhD, "Chapter 05: Establishing the First Satellite Center: “A Great Business and Clinical Story”" (2015). Interview Chapters. 954.
https://openworks.mdanderson.org/mchv_interviewchapters/954
Conditions Governing Access
Open
