Academic Medical Centers "Must Become More Nimble"

At the U.S. News Hospital of Tomorrow forum, executives offer ways to help ACE's face the future.

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If community hospitals are feeling pressure to cut costs and operate more efficiently, the sensation might be double or triple at academic medical centers, three executives suggested Tuesday at the inaugural US News Hospital of Tomorrow conference in Washington.

[READ: The Future of Academic Health Centers]

In addition to clinical care, academic medical centers have as part of their mission research and education, noted Dr. Ora H. Pescovitz, chief executive of the University of Michigan Health System. Sure, some people travel hundreds or thousands of miles to Ann Arbor, Mich., for advanced medical care, Pescovitz said, but academic medical centers like hers provide 41 percent of all charity care and 25 percent of all Medicaid hospitalizations nationwide.

With higher costs, bureaucracies and the need to support a broader mission than community hospitals, hers is "far and away" the most costly health system in Michigan, Pescovitz said.

[More Hospital of Tomorrow Forum coverage: usnews.com/hospitaloftomorrow]

The budget crisis in Washington is not helping. "We have been impacted by a triple whammy," Pescovitz continued. Medicare cuts have impacted reimbursements for charity care, plus academic institutions have been hit by a slowdown in research funding.

"In order to survive, academic medical centers must reinvent ourselves," Pescovitz said. Without adjustments, "other healthcare systems will simply eat our lunch."

Dr. Victor J. Dzau, president and CEO, Duke University Health System, Durham, N.C., said it was impossible to "cut our way" out of a funding shortfall. Instead, academic health centers need to find efficiencies through innovation. "I think this is an opportunity to emphasize innovation," Dzau said. "And the innovation has to come from us."

During a keynote session Monday, Dr. Robert C. Robbins, president and CEO, of Texas Medical Center in Houston, said that the medical "arms race" between competing organizations is over, and that collaboration is in. "The days of being a true triple threat may be over," Robbins said Tuesday.

At TMC, a massive campus of 21 hospitals and specialty care facilities, there are three heart transplant programs within a block, something Robbins appeared to call overkill. "It's not serving the community. It's not the best use of their resources," he said. With this in mind, session moderator Avery Comarow, US News & World Report's health rankings editor, asked each speaker to propose solutions to the crisis facing academic medicine. Pescovitz offered five ideas:

  • "We must prove our value to our payers, government and commercial."
  • "We must become more nimble."
  • "We need to reconsider how we provide education throughout our entire organization.
  • "We need to change the way we deliver care across the entire spectrum of the healthcare delivery system." Accountable care organizations and the patient-centered medical home model are steps in this direction, she said.
  • "We must deeply, deeply embrace and not give up our spirit of research and discovery." It would be "highly shortsighted" to think that research does not return gains, Pescovitz said, mentioning the Human Genome Project. She advised looking beyond the federal government, too, to private industry as potential funding sources.
  • Dzau had six points, some of which he discussed in a New England Journal of Medicine commentary in September:

    • "First, we need to begin to redefine our mission. We need to define why we are doing what we do. What's unique about us is that we are singularly focused on population health and reducing health disparities," he said. Education, patient care and research are merely tools. Duke actually rewrote its mission statement to reflect this philosophy.
    • Create systems, not centers. Be an integrated delivery system, Dzau advised.
    • Research should follow a "discovery-to-care continuum," from bench to bedside to population, and back.
    • "I think education is critically vital. But the critical issue is what are we trying to accomplish in education?"

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