The Roles of Academic Health Centers in the 21st Century A Workshop Summary (2002) / Chapter Skim
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Section III: Creating an Environment to Support Needed Changes
Section III: Creating an Environment to Support Needed Changes
Pages 22-34
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From page 22... ...
In his view, it is not clear that a national agency is needed to oversee such a process, although national standards could be helpful. SECTION III: CREATING AN ENVIRONMENT TO SUPPORT NEEDED CHANGES Critical Issues to Confront in Studying Academic Health Centers David Blumenthal, M.D., Executive Director, Commonwealth Task Force on Academic Health Centers David Blumenthal briefly described the Commonwealth Task Force on Academic Health Centers.
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From page 23... ...
The Commonwealth Task Force on Academic Health Centers defined an AHC as the nation's 121 four-year medical schools ant! their owned or affiliated clinical and educational entities.
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From page 24... ...
Examples are indirect medical education payments under Medicare and some Medicaid programs, the extra payments collected by AHCs in private markets, or state regulations that allocate higher clinical payments to AHCs. The advantages of indirect support are its flexibility, continuity of past ways of doing business anal reward for entrepreneurship, e.g.
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From page 25... ...
Jordan Cohen asked if the task force perceived a need for fundamental change in the way society pays for and establishes accountability for the AHC missions and if there is strong evidence that current policies are broken. Brian Biles suggested the neec!
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From page 26... ...
James Curran asked if it would be simpler to define support for the medical school and its affiliations rather than for academic health centers, so that the emphasis is on supporting the academic mission rather than rescuing hospitals and inefficient health centers.
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From page 27... ...
He conjectured that AHCs experienced more turmoil with the introduction of the resource-based relative value scale for physician payment than from all the changes made in medical education payments. The significant growth in clinical faculty over the last decades has fueled the growth in clinical service revenues, which affects clecision-making in AHCs more than hospital revenues.
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From page 28... ...
It will not be possible to have a hospital or specialty practice or even a primary care group in many parts of rural America without some form of subsidization. Christine Seidman asked if the joint production function included only the costs of clinical care and education, or if the research function is also included.
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From page 29... ...
The AHC receives revenues from a variety of sources, including tuition and appropriations, grants and contracts, and physician and hospital revenues. These revenues go into a single pool from which these diverse revenue sources are mingled together and are used to support the AHC missions in clinical care, research and education.
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From page 30... ...
Jeff Goldsmith suggested that if the hospital and its clinical services are the primary source of capital for many AHCs, then the hospital's primary purpose becomes earning the profit so the funds can be transferred elsewhere in the organization. To the extent this is true, the clinical enterprise may not receive the resources it needs to be a high performing organization.
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From page 31... ...
Variation in Roles Pursued by Academic Health Centers Gerard F Anderson, Ph.D., Professor and Director, Center for Hospital Finance and Management, The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University Gerard Anderson's presentation covered three areas: understanding the distribution of funds across AHC roles in research, graduate medical education and disproportionate share; issues of accountability; ant!
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From page 32... ...
, from Medicare for graduate medical education (as a measure of the size of the teaching function) , and Medicare disproportionate share funds (as a measure of the size of the indigent care program)
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From page 33... ...
It is hospital-centric, attributes NIH fiends that go to medical schools to the hospitals, mingles direct and indirect medical education funds, and uses absolute clolIars without accounting for institutional size. He believes that additional analysis and refinement of these figures are needed.
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From page 34... ...
Larry Lewin challenged the statement that DSH and NIH funding mechanisms have more accountability built into them than GME funding does. He noted that DSH funding is imprecise, yet has a significant impact on the size of the safety net, where it is located and whether it is oriented to outpatient or inpatient services.
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