continued
Clinical
The 1990s were characterized by great volatility in the world of health care.
As the decade progressed, rapidly escalating health care costs consumed an
increasingly larger portion of the gross national product, putting significant
pressure on corporate profits and a spotlight on the health care sector.
In 1998, the dean promoted Robert A. Barish, MD, a former flight surgeon and
medical volunteer in Cambodia and Somalia, from his 11-year position as director
of emergency medicine to the new position of associate dean for clinical affairs
to lead the clinical practice. Barish’s charge was to find order amid the
national economic chaos drifting toward the University of Maryland, as toward
all medical schools.
“We were not immune to what was happening in American medicine,” Barish says.
With the managed care payment model in place to restrain health care costs,
payers set fees and determined utilization rules. It was a dramatic shift
from the prevailing fee-for-service model.
Maryland entered the 1990s with managed care penetration at about 10 percent;
that figure had quadrupled by the end of the decade. As a result, the school’s
once-healthy faculty practice plan income declined dramatically.
Since the nation’s medical schools depend on reimbursement for patient care
to sustain their education and research mandates, those programs were in jeopardy.
To make matters worse, urban academic health centers are particularly vulnerable
because they provide care for a disproportionate number of uninsured patients.
From the fourteenth floor of the Bressler Research Building, the dean and
his senior administrators witnessed a decade of firsts. “Market pressures
forced the clinical faculty to compete with community practitioners for the
first time,” Barish explains. “Our faculty had to work harder and more efficiently
to achieve the
same results.”
In response to the market pressures, the leaders of the University, the School
of Medicine, and the hospital formed UniversityCare, an integrated clinical
care delivery organization. Its specialty risk contract for cardiology service
for 180,000 BlueCross BlueShield members was one of the first in the nation.
In addition to collaboration with the hospital, the physician group began
to launch joint ventures with the faculty, the prototype being a state-of-the-art
radiology facility in the physician-owned ambulatory professional building.
In 1996, the board of University Physicians, Inc., the independent faculty
physician practice plan, elected Dean Wilson president. He immediately formed
the clinical practices committee (now called the clinical affairs committee)
to increase participation by department chairs and faculty members. Practices
were standardized and made accountable to the dean.
Contrary to the prevailing opinion of business experts, Dean Wilson did not
follow plans adopted at other academic health centers. Despite recommendations
from consultants and colleagues to purchase private physician practices in
the community, the dean viewed the recommendation as “a flawed strategy and
formula for disaster.”
“Sometimes,” says Barish, “leaders are leaders when they make decisions that
are not popular.” He says the practice plan would have become insolvent if
the dean had followed the current “wisdom.”
Instead, the dean committed $1 million a year for five years to develop the
infrastructure to better manage clinical operations. The resulting redesign
of key processes improved collections to $98 million in Fiscal Year 1999,
the highest of the decade. In the new decade, collections rose another $7
million.
Barish says the chaos is being managed, but challenges remain. In this era
of decreasing reimbursement and increasing government regulations, clinical
practice groups must maintain a delicate balance between providing the best
patient care possible and reaching for the highest cost efficiency. As they
have in the past, the dean and his management team remain vigilant to economic
conditions and are prepared to implement appropriate responses.
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2001 In January, Dean Wilson reports a record $106.4 million income for the clinical practice plan. 2000 University Imaging Center opens in the Professional Building. Faculty time devoted to clinical activity continues to increase; however, the gap widens between clinical work volume and compensation as managed care insurers ratchet down reimbursement. 1999 Revenue drought ends; investment in redesign of critical business processes yields increased revenue. 1998 The dean creates the position of associate dean for clinical affairs and appoints Robert A. Barish, MD, to it. Redesign of critical business processes begins. 1997 State medical assistance transfers its patients into managed care. 1996 Dean Wilson is elected president of University Physicians, Inc. 1995 The school’s first primary care site, Edmonson Village, opens in west Baltimore. 1994 UniversityCARE is created in partnership with the University of Maryland Medical System to meet and anticipate the demands of the marketplace. 1993 Dean Wilson leads the first joint strategic planning process with medical school and hospital leadership. 1992 The faculty pledges $3 million to support the construction of an inpatient facility. Activity in the school's transplantation program is at an all-time high, with one-year survival rates at 100 percent for lung, 91 percent for heart, 90 percent for kidney, and 83 percent for pancreas transplants. |