Academic Health Centers Leading Change in the 21st Century (2004) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-18
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From page 1... ...
To this end, the external environment should create a set of incentives that will clearly signal the need for change and serve as a spur for actions by AHCs. In the area of education, Congress should create a dedicated fund that can support efforts to foster innovation in the methods and approaches used to prepare health professionals; in response, AHCs will need to examine fundamentally the methods and approaches used to prepare health professionals.
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As each AHC makes its own decisions on how to respond to its changing environment, it should recognize the interdependent and complementary nature of the AHCs' tradi tionally individual roles within an overall context and commitment to improving the health of the American people. While academic health centers (AHCs)
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For this report, the committee views an AHC not as a single institution, but as a constellation of functions and organizations committed to improving the health of patients and populations through the integration of their roles in research, education, and patient care to produce the knowledge and evidence base that become the foundation for both treating illness and improving health. Although AHCs vary in their organization and the emphasis placed on these roles, the committee believes they all face similar challenges.
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In the area of patient care, public and private payers and foundations should support experimentation in working across settings of care to redesign and restructure care processes aimed at improving the health of both patients and populations; in response, AHCs will need to create the structures and team approaches needed to focus on health for patients and populations. AHCs will not be able to take up the challenge of making the changes called for in each role with minor adaptations or a focus on each role in isolation from the others.
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It requires the purposeful linkage of these roles so that research develops the evidence base, patient care applies and refines the evidence base, and education teaches evidencebased and team-based approaches to care and prevention. Transforming the Roles of AHCs for the 21st Century Reforming the Education of Health Professionals AHCs have historically emphasized the education of physicians at the undergraduate and graduate levels, relying on the hospital's inpatient and outpatient settings as primary training sites.
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Health professions training is a major factor in creating the culture and attitudes that will guide a lifetime of practice. For most health professionals, more than half their training occurs in clinical settings rather than the classroom.
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and that use information technology in their clinical education programs. · To create this education innovation fund, Congress should redi rect the portion of the funding provided for indirect medical edu cation that exceeds the additional costs of caring for Medicare patients that are attributable to teaching activities (commonly referred to as the "empirical amount")
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. In its March 2003 Report to Congress, MedPAC expressed its dissatisfaction with current payment methods that provide no accountability for the use of funds beyond the Medicare payment amount related to increased patient care costs in teaching hospitals (Medicare Payment Advisory Commission, 2003)
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For example, to the extent that an AHC uses IME funds to subsidize care to the uninsured, there is a risk that such services could be curtailed.2 The Centers for Medicare and Medicaid Services and MedPAC should carefully monitor the effects of the establishment of the innovation fund for any deleterious effects. Although the proposed innovation fund can provide an incentive for immediate change, current funding methods for clinical education do not adequately support training in nonhospital settings, foster interdisciplinary approaches to training, or consider the relationship between the training of physician and nonphysician clinicians.
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b. Public and private payers, state and federal agencies, and founda tions should provide support for demonstration projects designed to test and evaluate the organizational structures and team approaches designed to improve health and prevent disease.
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, thereby increasing retention of health professionals and reducing dissatisfaction with the work environment. To encourage and support innovations aimed at redesigning care to improve health, public payers (such as the Centers for Medicare and Medicaid Services and state Medicaid programs)
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Rather, each should strategically assess its resources and capabilities to set priorities for how those resources can be applied to improve health, and to determine how it can establish and reward the collaborative, interdisciplinary approaches that characterize clinical, health services, and prevention research, and support the types of collaborations needed for translating discoveries into practice. For example, applying the knowledge of genetics to care will require not only basic research to understand the mechanisms involved, but also clinical and prevention research to apply results to care, attention to issues of organizational design so providers can deliver the care, an understanding of costs and financing to build use of that knowledge into the health system, and a focus on how to educate patients and professionals so everyone understands the potential and limitations of the resulting care.
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Information and communications technology is central to all of the roles of AHCs. Basic biomedical research is becoming increasingly reliant on such technology.
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, as well as all the knowledge that is useful and/or essential to the proper management of institutions, teams, departments, and interdisciplinary efforts for conducting clinical care, research, and education (The Blue Ridge Academic Health Group, 2000)
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develop ing organizational structures and team approaches in care to improve health; and (3) increasing emphasis on health services, clinical, preven tion, and translational research.
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Manage the organizational and systems changes necessary to im prove health through innovation in health professions education, patient care, and research.
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They need to speak loudly and clearly for the actions necessary to improve the health of the public, including, for example, the provision of health insurance for all Americans. Meeting this need may be a challenge in that some actions that would improve health may not benefit a specific AHC; for example, better models of care may reduce inpatient admissions, resulting in negative financial consequences for an AHC's hospital.
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