academic medical centers

Case study: Detroit med school carries $50M/year in uncompensated care

Anne Zieger — Fri, 29 Aug 2008 14:51:29 -0400

If you're an urban medical school, you expect to care for a high volume of the city's struggling poor and uninsured patients. That's particularly true in Detroit, where Wayne State University cares for 70 percent of the city's estimated 200,000 residents. About 750 Wayne State University Medical School physicians take care of these patients, whose numbers continue to grow as cuts continue among the city's manufacturing, auto and other industries.

All told, roughly 75 percent of doctors treated at academic medical centers are uninsured or underinsured, according to Wayne State's assistant dean of Community and Urban Health. The school puts the cost of uncompensated care--including free care provided by doctors and care for which they haven't been paid--at about $50 million per year. Not only is Wayne State struggling, Detroit Medical Center is suffering financially too. DMC, an eight-hospital system, gives about $200 million in uncompensated care each year in Detroit, including care for more Medicaid patients than any other hospital or group of hospitals in the state.

While the city does pay for some indigent care, through its three primary care facilities and three specialty clinics, its funding is scarce, limiting its ability to help poor patients avoid expensive ED care, and some care is covered by the Voices of Detroit Initiative. But otherwise, many of the urban poor are left to rely on a system that may not be there forever to support them.

To learn more about Wayne State:
- read this Chicago Tribune piece

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Saying 'I'm sorry' grows more popular in med mal cases

Tue, 20 May 2008 06:59:58 -0400

Historically, in medical malpractice situations, attorneys have advised doctors and hospitals to deny that any medical error has been made--or even express any form of regret that a patient is suffering. However, there's some evidence that this approach may be changing. A recent piece in the New York Times, for example, notes that a growing number of academic medical centers are experimenting with new approaches that stress quick disclosure of medical errors, honest apologies and fair compensation. By doing so, they hope to clear the air quickly, learn from their mistakes and avoid needless litigation. The approach seems to be working, as anecdotal evidence suggests that these hospitals are seeing legal savings and lower rates of lawsuits.

One institution that has tried this approach, the University of Michigan Health System, saw existing claims and lawsuits drop to 83 in August 2007 from 262 in August 2000. The hospital's legal defense costs and set-aside funds were down by two-thirds and time taken to dispose of cases has been cut in half, according to the medical center's chief risk officer. Another institution that has taken this track, the University of Illinois, has seen the number of malpractice claims filed cut in half in just over two years. Also, in 37 cases where the hospital admitted a preventable error and apologized, only one patient filed suit.

To learn more about this trend:
- read this piece from The New York Times

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ALSO NOTED: CDC grants to help RHIOs share public health data; AHRQ awards millions for clinical-decision support systems; and

Mon, 17 Mar 2008 07:59:50 -0400

> The CDC has awarded $38 million in contracts to help health information exchanges and regional health information organizations to create data sharing plans used to deliver information to public health authorities. Report

> Two academic medical centers have been awarded contracts worth a total of $5 million by the Agency for Healthcare Research and Quality to develop clinical decision-support tools. Report

> Aetna has become the latest in a crowded field of PHR contenders, going up against everyone from Google and Microsoft to giant employer coalitions Dossia and WebMD. Report

And Finally... IMS Health is out with its new annual pharma sales report, and it's not pretty. Revenue grew by only 3.8 percent to $286.5 billion, the slowest pace of expansion since 1961. By contrast, sales expanded by 6 percent in 2006. Total prescription volume rose only by 2.8 percent, compares with 4.6 percent the previous year. Report

Group says Stark rules unfair to for-profits

Mon, 14 Jan 2008 06:59:57 -0500

Though they haven't been implemented yet, the revised Stark rules which went into effect December 4, 2007 have come under fire from at least one powerful hospital group, which says they aren't fair. The Federation of American Hospitals says changes to the "stand in the shoes" doctrine--under which group practices are held responsible for any referral relationship between a physician and a hospital--would hit them too harshly. To date, academic medical centers and not-for-profit systems have been able to convince CMS that support payments to their affiliated physician groups were necessary, but for-profit hospitals haven't been given the same latitude. Now, FAH is asking CMS to expand the rule to address their needs, which they say are identical to the academic medical centers and not-for-profit hospitals. They have less than 12 months to convince CMS, which put implementation of the new rules on hold for a year last November.

To find out more about the issue:
- read this Modern Healthcare article (reg. req.)

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Study: Med school pharma limits affect attitudes

Tue, 04 Dec 2007 06:59:55 -0500

Of late, academic medical centers have been instituting tough limits on pharmaceutical companies' relationship with their faculty and staff. On their face, the policies seem to be aimed primarily at insulating working physicians from pressure to buy new, costly drugs. However, it seems that such policies have a secondary effect as well. A new study published in the journal Pediatrics suggests that when medical schools and teaching hospitals limit on pharma access to med students and residents, the students and residents end up with different attitudes about pharma interaction than their peers.

The study, which reviewed 12 other studies published over the past 16 years, found that imposing even minimal limits tended to produce doctors who were more skeptical about product information coming from drug reps. Requiring even a single hour of pharma-related training had a measurable effect on doctor-pharma relationships as well. Not surprisingly, however, the effect of imposing pharma limits was greatest when med schools banned all contact between students and residents.

To learn more about the study:
- read this Modern Healthcare article

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CMS to put part of "Stark III" on hold

Mon, 12 Nov 2007 06:59:57 -0500

CMS has announced that it will partially delay implementing a provision in "Stark III" rules for one year. CMS is putting a hold on the "stand-in-the-shoes" physician self-referral prohibition contained within Stark, at least where it pertains to academic medical centers and not-for-profit integrated health systems. The rest of the rule will go into effect December 4.

When enacted, the provision will ratchet down exemption which made it easier for physicians to have indirect financial relationships with the hospitals to which they refer. Rather than having a hands-off standing, physicians will be considered to "stand in the shoes" of their practices. However, academic medical centers and not-for-profit integrated health systems have argued that under the new rules, they'd be unable to offer physicians "support payments" which are routinely made to affiliated physicians and considered acceptable under other Stark exceptions.

To learn more about the delay:
- read this Modern Healthcare piece (reg. req.)

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UConn considers pharma gift ban

Thu, 25 Oct 2007 06:59:58 -0400

The University of Connecticut Health Center may become the next academic medical institution to set limits on drug- and medical device-maker gifts to staff and students. A committee of administrators and students there have drafted a policy on the subject, unveiled during this week's American Medical Student Association's "PharmFree Week" event. The guidelines would not only ban gifts over $100, but also specify that only modest meals would be allowed at educational presentations.

Medical students at the Center say they're taking action because they're concerned about the level of marketing already reaching them, which they feel could have an undue influence on future prescribing patterns. For example, students say they're already being offered gifts like free lunches and stethoscopes when they train at primary care clinics.

If the initiative succeeds, UConn would be one of a growing number of health systems and academic medical centers adopting such policies. Many others, including the Henry Ford Health System, Stanford University, Yale University, the University of Pennsylvania, University of California at Davis and Boston University, already have such policies in place.

To learn more about the proposed ban:
- read this Hartford Courant article

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Study: Drug, devicemaker ties with academic ctrs common

Wed, 17 Oct 2007 06:59:57 -0400

A new study suggests that academic medical centers have tight relationships with pharmas and medical-device makers, perhaps tighter than previously thought. The study, which was done by researchers at the Massachusetts General Hospital Institute for Health Policy, found that 67 percent of teaching hospital departments and 60 percent of department heads had a compensated relationship with a drug or device maker. Meanwhile, about 65 percent of medical schools had such relationships.

The relationships between these companies and academic medical centers included consulting relationships, speaking opps, advisory board memberships and intellectual property partnerships--not to mention education program funding and support for residency and fellowship training.

To learn more about the study:
- read this Modern Healthcare article

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U of Kansas makes stunning turnaround

Thu, 11 Oct 2007 06:59:54 -0400

It was kudos all around this week for the University of Kansas Hospital, which has gone from a state of financial and clinical crisis to being named as a top quality performer ranked with some of the top facilities in the country. As of ten years ago, the hospital had abysmal patient satisfaction scores, rapidly falling patient volumes, rapid employee turnover and a fast-deteriorating financial situation.

Today, however, the hospital is ranked fifth place on rankings by the University HealthSystem Consortium, a group of 97 academic medical centers. That puts it on similar footing as marquee names like the Mayo Clinic and Brigham and Women's Hospital. The consortium ranked the hospital on about 40 measures of quality, reliance on best practices and efforts to cut care disparities among race, sex and economic status of patients.

While the forces behind the turnaround are complex, many observers say it began in earnest when hospital governance was moved outside of the medical school and into a new hospital governing authority stocked with professional managers. Also, once the hospital stepped out of the state university system, it was able to make much-needed capital investments.

To learn more about the U of K transformation:
- read this article from The Kansas City Star

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U of Pitt Med Center plans drug, device gift ban

Wed, 04 Jul 2007 20:01:38 -0400

The University of Pittsburgh Medical Center (UPMC) is poised to implement a new policy banning physicians and other employees from accepting virtually any type of pharma or device-maker freebies. If it moves ahead, UPMC would join a growing list of academic medical centers and other facilities that have instituted tight controls on such gifts. Employees and physicians who break the rules could face written reprimands and even loss of hospital privileges.

To address concerns raised by the plan's biggest critics--who say barring the acceptance of samples would harm poor patients--the school would look into setting up a voucher program giving patients access to meds at no cost to them. Only if the voucher approach failed would providers be allowed to make a special request for samples. The problem, critics say, is that such an approach could dramatically delay drug access by the poor and uninsured. Some institutions instituting similar controls, such as the Henry Ford Health System, have continued to permit physicians to accept samples under some circumstances.

To find out more about this trend:
- read this Pittsburgh Post-Gazette piece

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