(Philadelphia, PA) - Today's academic medical centers (AMCs) need to embrace the changing healthcare marketplace or run the risk of becoming the next Kodak - a former industrial giant that became obsolete when it failed to adapt to a shifting technological landscape.
That is the premise of a commentary published this month electronically ahead of the print edition of Academic Medicine, the journal of the Association of American Medical Colleges. The commentary is authored by Verdi DiSesa, MD, MBA, Chief Operating Officer of the Temple University Health System (TUHS) and Vice Dean for Clinical Affairs and Professor of Surgery at Temple University School of Medicine (TUSM), and Larry Kaiser, MD, President and CEO of TUHS, Senior Executive Vice President for Health Affairs at Temple University, and Dean and Professor of Surgery at TUSM.
"AMCs and those who lead them need to recognize that they are in a business that is transitioning from a system of 'sickness' care to one of 'health' care, accountable for the health of defined populations and for the value of the services provided," says Dr. DiSesa.
According to the authors, a failure to recognize the importance of this transition may impair AMCs irrevocably. They argue that leaders of academic medicine need to understand, respond to and ultimately lead the transformation toward a population health paradigm which demands the best combination of preventive and therapeutic services to deliver the best outcomes at the lowest overall cost.
"Historically, payments have been based on volume - do more for more patients and get paid more," says Dr. Kaiser. "The system fostered incentives to increase the number of services. We are now groping our way to an era in which 'value' will replace 'volume' as the measure driving payment for service. Payers, regulators and patients are demanding a shift from a system of intervention for episodes of illness - 'sickness care' - to one which maximizes the health of the population served - 'health care.'"
In their commentary, the authors review the pressures driving healthcare changes, including value-based purchasing, "observation" status, denial of payments for re-admission, "risk" contracts, "tiering" based on historical costs, accountable care, and payer-mandated medical management. They also offer potential responses to these challenges, including:
- Redesign the delivery mechanisms for specialty referral services by reorganizing them into multi-disciplinary systems of care, usually focused on an organ system (e.g., Heart Institute) or disease process (e.g., Cancer Center), and which engage patients in lifetime health management through a combination of hospital-based and outpatient services
- Position AMCs as the tertiary/quaternary hub in a networked system of lower cost-basis community hospitals and outpatient resources
- Create new fields of medical specialization such as "observation medicine" or "low-cost hospital medicine," which also incorporate telemedicine and "virtual" outpatient visits into their practice
- Accelerate the growth of population health and accountable care as academic disciplines.
"To survive, AMCs will need to become an integral part of a system in which enhancement of population health is the explicit mission," says Dr. DiSesa. "This transformation presumably must be accomplished while the AMCs still fulfill their traditional missions of advanced patient care, teaching and research. It's likely that some AMCs will need to redefine their mission and not try to be everything for everyone."
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About Temple Health
Temple University Health System (TUHS) is a $1.8 billion academic health system dedicated to providing access to quality patient care and supporting excellence in medical education and research. The Health System consists of Temple University Hospital (TUH), ranked among the "Best Hospitals" in the region by U.S. News & World Report; TUH-Episcopal Campus; TUH-Northeastern Campus; Fox Chase Cancer Center, an NCI-designated comprehensive cancer center; Jeanes Hospital, a community-based hospital offering medical, surgical and emergency services; Temple Transport Team, a ground and air-ambulance company; and Temple Physicians, Inc., a network of community-based specialty and primary-care physician practices. TUHS is affiliated with Temple University School of Medicine.
Temple University School of Medicine (TUSM), established in 1901, is one of the nation's leading medical schools. Each year, the School of Medicine educates approximately 840 medical students and 140 graduate students. Based on its level of funding from the National Institutes of Health, Temple University School of Medicine is the second-highest ranked medical school in Philadelphia and the third-highest in the Commonwealth of Pennsylvania. According to U.S. News & World Report, TUSM is among the top 10 most applied-to medical schools in the nation.
Temple Health refers to the health, education and research activities carried out by the affiliates of Temple University Health System (TUHS) and by Temple University School of Medicine. TUHS neither provides nor controls the provision of health care. All health care is provided by its member organizations or independent health care providers affiliated with TUHS member organizations. Each TUHS member organization is owned and operated pursuant to its governing documents.
Journal
Academic Medicine