AM Rounds

Beyond the pages of Academic Medicine, journal of the AAMC

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Practice What You Teach: Academic Medical Centers and Responsible Health Care

By Sheldon M. Retchin, MD, Vice President for Health Sciences, Virginia Commonwealth University, and Chief Executive Officer, VCU Health System

As our nation ponders different models of health care to stem the rising tide of costs, high deductible plans have become increasingly popular instruments for engaging consumers in their own care decisions. With the availability of health care information on the rise and the number of public websites devoted to provider reports growing rapidly, consumerism for health care choice is no longer an empty pipe dream.

Patients are being rapidly transformed into active consumers, and they are seeking answers to thorny questions about the value and quality of care. If this consumer engagement is here to stay, it may well end up as a unique feature of an American brand of care. If so, what role will the nation’s academic medical centers play in this unfolding drama? Thus far, academic medicine has played a dominant part in the creation of advanced knowledge to benefit consumers, but we have had a trivial role in enhancing the understanding of information for consumers. As academic medical centers seek to convince consumers they are worthy of leading health care redesign efforts, and providing reformed care themselves, they are under the glare of a public spotlight. We may be a lot of things, but efficiency and wellness are not our strong suits, and there is nothing more damaging to the public confidence than insincerity.

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Seizing the Health Care Reform Opportunity at our Doorstep

By Darrell G. Kirch, MD, AAMC President and CEO

From 2000 to 2006, I had the privilege of serving as senior vice president for health affairs, dean of the college of medicine, and chief executive officer of the Milton S. Hershey Medical Center at The Pennsylvania State University. During that time, we undertook a major overhaul of our health care system to improve care and lower costs. The efforts are outlined in an article in the March issue of Academic Medicine, “Employee Health Benefit Redesign at the Academic Health Center: A Case Study.” Given that most of the changes we made are still in place, it is clear the major lesson still stands: for academic medical centers, health reform opportunities lie at our own doorstop.

During my time at Penn State Hershey Medical Center (PSHMC), the national discussion that ultimately culminated in the passage of the Affordable Care Act was just beginning. What was painfully apparent was that the projections of our institutional spending on health care benefits for our faculty and staff presented a serious fiscal threat to our medical center. Between 2000 and 2005, we observed the health care costs of PSHMC rise at alarming double-digit rates. Equally painful was the fact that, when the data on our utilization of services were examined, opportunities to improve the health of our own people were being missed. For example, we found that routine preventive screening tests were being underutilized. As a self-insured institution, we were devoting more and more of our resources to “sick care,” which increased employee contribution rates and limited our ability to focus on wellness and prevention and improve the health of our community.

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