Dr. Herbert Pardes wants to see more attention given to the problems facing the current healthcare system before the nation’s academic medical centers are inadvertently damaged. As President and President and CEO of New York-Presbyterian Hospital in New York City affiliated with Columbia College of Physicians and Surgeons and Weill Cornell Medical College, he spoke at the National Press Club on March 31st.
Dr. Pardes pointed out that academic medical centers provide the best in clinical care, provide the bulk of medical innovation and life saving techniques, cover all diseases and medical conditions, provide all levels of care, and therefore are well positioned to help lead the transformation that will occur because of health reform.
He said that this country has many fine hospitals, rural, community and specialty hospitals, but academic medical centers have a special place. Academic centers take care of the largest number of the most vulnerable and neediest patients. Even though the academic centers constitute only 6 percent of all hospitals, they provide 41 percent of the charity care, 28 percent of Medicaid, 22 percent of Medicare, and at the same time, provide care to the undocumented which imposes an ongoing burden.
Since academic medical centers treat the sickest most complex cases and the most vulnerable patients, “value based purchasing” as enacted in health reform legislation could wind up rewarding hospitals in more affluent areas and punishing excellent hospitals in challenged communities where many academic medical centers are located. In addition, the rules for hospital readmissions could penalize academic medical centers since they treat the poorest patients with multiple conditions.
Academic medical centers are also vulnerable to cost-cutting efforts because they seem more expensive to run than other types of hospitals since these institutions have a higher cost base. There is the danger that in the desire to reduce costs across the board, academic medical centers could be disproportionately impacted because of their higher cost base.
Another serious major problem this country faces is going to be the shortage of physicians. By 2014, 32 million more Americans will have health insurance and will need access to care. In addition, the vast numbers of baby boomers are reaching retirement age and facing the increased medical needs of old age. Providing for this healthcare will not be possible if the Association of American Medical Colleges’ projection of a shortage of 130,000 physicians by 2025 takes place.
Academic medical centers are making great efforts to address and stimulate quality. For example, New York-Presbyterian residents have formed their own quality councils as a way to give doctors-in-training a direct role in developing and implementing quality standards. The medical center is also developing a healthcare model based on data mining to identify the highest-cost patients and using predictive modeling to find out which patients are likely to be readmitted to the hospital.
Dr. Pardes emphasized that new innovative approaches have to go forward to manage high-cost patients and gave several examples of programs currently taking place:
• Duke has developed a health management program called “Just for Us” to provide in home visits to seniors when they are part of an integrated team of care providers
• Massachusetts General has built an intervention program for seniors to reduce Medicare expenditures for their senior population by 12 percent
• Emory University Healthcare has developed an innovative system for patient and family care management across the spectrum of care
• UCLA has developed a Pediatric Medical Home for coordinating care and has found that emergency room visits have been reduced
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