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Romero R. Leaders in Academic Medicine: a profile of Arthur S. Levine, MD. Am J Obstet Gynecol 2022; 226:327-334. [PMID: 35260226 PMCID: PMC11027118 DOI: 10.1016/j.ajog.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Detroit, MI.
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Jacko JA, Sainfort F, Messa CA, Page TF, Vieweg J. Redesign of US Medical Schools: A Shift from Health Service to Population Health Management. Popul Health Manag 2021; 25:109-118. [PMID: 34227892 DOI: 10.1089/pop.2021.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The integration of medical schools and clinical partners is effectively established through the formation of academic medical centers (AMCs). The tripartite mission of AMCs emphasizes the importance of providing critical clinical services, medical innovation through research, and the education of future health care leaders. Although AMCs represent only 5% of all hospitals, they contribute substantially to serving disadvantaged populations of patients, including an estimated 37% of all charity care and 26% of all Medicaid hospitalizations. Currently, most AMCs use a business model centered upon revenue generated from hospital services and/or practice plans. In the last decade, mounting financial demands have placed significant pressure on AMC finances because of the rising costs associated with complex clinical care and operating diverse graduate medical education programs. A shift toward population health-centric health care management strategies will profoundly influence the predominant forms of health care delivery in the United States in the foreseeable future. Health systems are increasingly pursuing new strategies to manage financial risk, such as forming Accountable Care Organizations and provider-sponsored plans to provide value-based care. Refocusing research and operational capacity toward population health management fosters collaboration and enables reintegration with hospital and clinical partners across care networks, and can potentially create new revenue streams for AMCs. Despite the benefits of population health integration, current literature lacks a blueprint to guide AMCs in the transformation toward sustainable population health management models. The purpose of this paper is to propose a modern conceptual framework that can be operationalized by AMCs in order to achieve a sustainable future.
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Affiliation(s)
- Julie A Jacko
- Dr. Kiran C. Patel College of Allopathic Medicine, Department of Population Health Science, Nova Southeastern University, Fort Lauderdale, Florida, USA.,H. Wayne Huizenga College of Business and Entrepreneurship, Department of Management, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - François Sainfort
- Dr. Kiran C. Patel College of Allopathic Medicine, Department of Population Health Science, Nova Southeastern University, Fort Lauderdale, Florida, USA.,H. Wayne Huizenga College of Business and Entrepreneurship, Department of Management, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Charles A Messa
- H. Wayne Huizenga College of Business and Entrepreneurship, Department of Management, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Timothy F Page
- H. Wayne Huizenga College of Business and Entrepreneurship, Department of Management, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Johannes Vieweg
- Dr. Kiran C. Patel College of Allopathic Medicine, Department of Population Health Science, Nova Southeastern University, Fort Lauderdale, Florida, USA
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O'Hanlon CE. Impacts of Health Care Industry Consolidation in Pittsburgh, Pennsylvania: A Qualitative Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020976246. [PMID: 33233979 PMCID: PMC7691888 DOI: 10.1177/0046958020976246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
While most studies of health care industry consolidation focus on impacts on
prices or quality, these are not its only potential impacts. This exploratory
qualitative study describes industry and community stakeholder perceptions of
the impacts of cumulative hospital, practice, and insurance mergers,
acquisitions, and affiliations in Pittsburgh, Pennsylvania. Since the 1980s,
Pittsburgh’s health care landscape has been transformed and is now dominated by
competition between 2 integrated payer-provider networks, health care system
UPMC (and its insurance arm UPMC Health Plan) and insurer Highmark (and its
health care system Allegheny Health Network). Semi-structured interviews with 20
boundary-spanning stakeholders revealed a mix of perceived impacts of
consolidation: some positive, some neutral or ambiguous, and some negative.
Stakeholders perceived consolidation’s positive impacts on long-term viability
of health care facilities and their ability to adopt new care models, enhanced
competition in health insurance, creation of foundations, and pioneering medical
research and innovation. Stakeholders also believed that consolidation changed
geographic access to care, physician referral behaviors, how educated patients
were about their health care, the health care advertising environment, and
economies of surrounding neighborhoods. Interviewees noted that consolidation
raised questions about what the responsibilities of non-profit organizations are
to their communities. However, stakeholders also reported their perceptions of
negative outcomes, including ways in which consolidation had potentially reduced
patient access to care, accountability and transparency, systems’ willingness to
collaborate, and physician autonomy. As trends toward consolidation are not
slowing, there will be many opportunities to experiment with policy levers to
mitigate its potentially negative consequences.
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Affiliation(s)
- Claire E O'Hanlon
- Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
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Chari R, O'Hanlon C, Chen P, Leuschner K, Nelson C. Governing Academic Medical Center Systems: Evaluating and Choosing Among Alternative Governance Approaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:192-198. [PMID: 28906263 DOI: 10.1097/acm.0000000000001903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The ability of academic medical centers (AMCs) to fulfill their triple mission of patient care, medical education, and research is increasingly being threatened by rising financial pressures and resource constraints. Many AMCs are, therefore, looking to expand into academic medical systems, increasing their scale through consolidation or affiliation with other health care systems. As clinical operations grow, though, the need for effective governance becomes even more critical to ensure that the business of patient care does not compromise the rest of the triple mission. Multi-AMC systems, a model in which multiple AMCs are governed by a single body, pose a particular challenge in balancing unity with the needs of component AMCs, and therefore offer lessons for designing AMC governance approaches. This article describes the development and application of a set of criteria to evaluate governance options for one multi-AMC system-the University of California (UC) and its five AMCs. Based on a literature review and key informant interviews, the authors identified criteria for evaluating governance approaches (structures and processes), assessed current governance approaches using the criteria, identified alternative governance options, and assessed each option using the identified criteria. The assessment aided UC in streamlining governance operations to enhance their ability to respond efficiently to change and to act collectively. Although designed for UC and a multi-AMC model, the criteria may provide a systematic way for any AMC to assess the strengths and weaknesses of its governance approaches.
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Affiliation(s)
- Ramya Chari
- R. Chari is policy researcher, RAND Corporation, Arlington, Virginia; ORCID: http://orcid.org/0000-0002-6805-0974. C. O'Hanlon is assistant policy researcher, RAND Corporation, and a doctoral candidate, Pardee RAND Graduate School, Santa Monica, California; ORCID: http://orcid.org/0000-0001-6398-5845. P. Chen is physician policy researcher, RAND Corporation, Santa Monica, California. K. Leuschner is research communications analyst, RAND Corporation, Santa Monica, California. C. Nelson is senior political scientist, RAND Corporation, and professor of policy analysis, Pardee RAND Graduate School, Santa Monica, California
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Abstract
SummaryThousands of papers have been published on the biological associations with psychosis yet this has had a limited impact on the routine clinical care of people with psychosis. Cognitive dysfunction, genetics and neuroimaging are the research areas likely to integrate into clinical practice in psychosis most rapidly. Clinical and academic collaborations in partnership with patients and carers are necessary to make progress, along with an acceptance that not all new approaches will necessarily prove effective in the longer term. Most discoveries do not just jump from bench to bedside, but require active interactions between scientists and clinicians.
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Health System Creation and Integration at a Health Sciences University: A Five-Year Follow-up. J Healthc Manag 2017; 62:386-402. [PMID: 29135763 DOI: 10.1097/jhm-d-16-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY Shifting healthcare market forces and regulation have exerted near-constant pressure on U.S. academic health centers (AHCs) attempting to successfully execute their traditional tripartite mission. A governance structure and organizational alignment that works well under one set of conditions is rarely optimal when conditions change. Thus, the degree and type of alignment of an AHC's clinical, educational, and faculty practice organizations have changed regularly within the sector, typically landing near one end or the other on a continuum from fully aligned with centralized governance to largely independent with separate governance. The authors examine the case of Georgia Regents University and Health System in this context. In step with industry trends, the institution's governance structure swung from fully aligned/centralized governance in the early 1990s to essentially separate and decentralized by 2000. In 2010, the Georgia Regents University organizations achieved rapid realignment by creating a governance structure of sufficient strength and flexibility to absorb and adjust to continuing external upheaval. The hospitals, clinics, and physician-faculty practice group were combined into one integrated health system, then aligned with the university to form the state's only public AHC under aligned, but distinct, corporate and management structures. The years since reorganization have seen significant growth in patient volumes and complexity, improved service quality, and enhanced faculty physician satisfaction, while also significantly increasing economic contributions from the health system to the academic mission. This case study offers observations and lessons learned that may be useful to other higher education institutions considering reorganization.
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Costlow MR, Landsittel DP, James AE, Kahn JM, Morton SC. Model for a patient-centered comparative effectiveness research center. Clin Transl Sci 2015; 8:155-9. [PMID: 25588873 DOI: 10.1111/cts.12257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This special report describes the systematic approach the University of Pittsburgh and the University of Pittsburgh Medical Center (UPMC) undertook in creating an infrastructure for comparative effectiveness and patient-centered outcomes research resources. We specifically highlight the administrative structure, communication and training opportunities, stakeholder engagement resources, and support services offered.
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Affiliation(s)
- Monica R Costlow
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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Kairouz VF, Raad D, Fudyma J, Curtis AB, Schünemann HJ, Akl EA. Assessment of faculty productivity in academic departments of medicine in the United States: a national survey. BMC MEDICAL EDUCATION 2014; 14:205. [PMID: 25257232 PMCID: PMC4189191 DOI: 10.1186/1472-6920-14-205] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 09/23/2014] [Indexed: 05/27/2023]
Abstract
BACKGROUND Faculty productivity is essential for academic medical centers striving to achieve excellence and national recognition. The objective of this study was to evaluate whether and how academic Departments of Medicine in the United States measure faculty productivity for the purpose of salary compensation. METHODS We surveyed the Chairs of academic Departments of Medicine in the United States in 2012. We sent a paper-based questionnaire along with a personalized invitation letter by postal mail. For non-responders, we sent reminder letters, then called them and faxed them the questionnaire. The questionnaire included 8 questions with 23 tabulated close-ended items about the types of productivity measured (clinical, research, teaching, administrative) and the measurement strategies used. We conducted descriptive analyses. RESULTS Chairs of 78 of 152 eligible departments responded to the survey (51% response rate). Overall, 82% of respondents reported measuring at least one type of faculty productivity for the purpose of salary compensation. Amongst those measuring faculty productivity, types measured were: clinical (98%), research (61%), teaching (62%), and administrative (64%). Percentages of respondents who reported the use of standardized measurements units (e.g., Relative Value Units (RVUs)) varied from 17% for administrative productivity to 95% for research productivity. Departments reported a wide variation of what exact activities are measured and how they are monetarily compensated. Most compensation plans take into account academic rank (77%). The majority of compensation plans are in the form of a bonus on top of a fixed salary (66%) and/or an adjustment of salary based on previous period productivity (55%). CONCLUSION Our survey suggests that most academic Departments of Medicine in the United States measure faculty productivity and convert it into standardized units for the purpose of salary compensation. The exact activities that are measured and how they are monetarily compensated varied substantially across departments.
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Affiliation(s)
- Victor F Kairouz
- />Department of Medicine, State University of New York at Buffalo, Buffalo, New York, USA
| | - Dany Raad
- />Department of Medicine, State University of New York at Buffalo, Buffalo, New York, USA
| | - John Fudyma
- />Department of Medicine, State University of New York at Buffalo, Buffalo, New York, USA
| | - Anne B Curtis
- />Department of Medicine, State University of New York at Buffalo, Buffalo, New York, USA
| | - Holger J Schünemann
- />Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada
- />Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Elie A Akl
- />Department of Medicine, State University of New York at Buffalo, Buffalo, New York, USA
- />Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada
- />Department of Internal Medicine, American University of Beirut, Riad-El-Solh, P.O. Box: 11-0236, Beirut, 1107 2020 Lebanon
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Filler G, Burkoski V, Tithecott G. Measuring physicians' productivity: a three-year study to evaluate a new remuneration system. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:144-152. [PMID: 24280837 DOI: 10.1097/acm.0000000000000058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To evaluate a new assessment tool measuring physicians' academic productivity and its use in a performance-based remuneration system. METHOD The authors developed an assessment tool based on existing tools to measure productivity. Yearly, from 2008 to 2011, physicians at the University of Western Ontario received a score of up to three points for each of four components (impact, application, scholarly activity, mentorship) in each of four domains (clinical practice, education, research, administration). Scores were weighted by the percentage of time physicians spent on tasks in each domain. Year 1 scores were a baseline. In Years 2 and 3, scores were tied to remuneration. The authors compared scores and associations, accounting for age and academic rank, across the three years. RESULTS The 37 participating physicians included 11 assistant, 23 associate, and 4 full professors. The mean weighted total baseline score across all four domains was 7.44. Years 2 and 3 scores were highly correlated with Year 1 scores (r = 0.85, Years 1 and 2; r = 0.89, Years 1 and 3). Year 2 mean weighted scores did not differ significantly from Year 1 scores. Assistant professors' scores improved significantly between Years 1 and 2 (+1.08, P < .001). Lower Year 1 scores were correlated with a greater improvement in scores between Years 1 and 2, and age was negatively correlated with score changes between Years 2 and 3. CONCLUSIONS Although the tool may be a robust measurement of physicians' productivity, performance-based remuneration had no effect on physicians' overall performance.
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Affiliation(s)
- Guido Filler
- Dr. Filler is professor and chair, Department of Pediatrics, University of Western Ontario, and chief, Children's Hospital, London Health Science Centre, London, Ontario, Canada. Dr. Burkoski is vice president/chief nursing executive, Quality, Patient Safety, and Professional Practice, London Health Science Centre, London, Ontario, Canada. Dr. Tithecott is assistant professor, Department of Pediatrics, and associate dean of undergraduate medical education, University of Western Ontario, London, Ontario, Canada
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Keroack MA, McConkie NR, Johnson EK, Epting GJ, Thompson IM, Sanfilippo F. Functional alignment, not structural integration, of medical schools and teaching hospitals is associated with high performance in academic health centers. Am J Surg 2011; 202:119-26. [PMID: 21718960 DOI: 10.1016/j.amjsurg.2011.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 05/16/2011] [Accepted: 05/16/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Debates continue regarding optimal structures for governance and administration between medical schools and their teaching hospitals. METHODS Structural integration (SI) for 85 academic health centers was characterized as high (single leader or fiduciary) or low (multiple leaders or fiduciaries). Functional alignment (FA) was estimated from questionnaire responses by teaching hospitals' chief executive officers, and an index was calculated quantifying organizational collaboration across several functional areas. SI and FA were examined for their association with global performance measures in teaching, research, clinical care, finance, and efficiency. RESULTS AHCs with high SI had significantly higher FA, though overlap between high-SI and low-SI institutions was considerable. SI was not significantly associated with any performance measure. In contrast, FA was significantly associated with higher performance in teaching, research, and finance but not clinical care and efficiency. CONCLUSIONS FA between medical schools and their primary teaching hospitals more strongly predicts academic health centers' performance than does SI. As demands for greater collaboration increase under health reform, emphasis should be placed on increasing FA rather than SI.
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Geisler BP, Widerberg KF, Berghöfer A, Willich SN. Leadership in health care: developing a post-merger strategy for Europe's largest university hospital. J Health Organ Manag 2010; 24:258-76. [PMID: 20698402 DOI: 10.1108/14777261011054608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper's aim is to identify existing and developing new concepts of organization, management, and leadership at a large European university hospital; and to evaluate whether mixed qualitative-quantitative methods with both internal and external input can provide helpful views of the possible future of large health care providers. DESIGN/METHODOLOGY/APPROACH Using the Delphi method in semi-structured, semi-quantitative interviews, with managers and employees as experts, the authors performed a vertical and a horizontal internal analysis. In addition, input from innovative faculties in other countries was obtained through structured power questions. These two sources were used to create three final scenarios, which evaluated using traditional strategic planning methods. FINDINGS There is found a collaboration scenario in which faculty and hospital are separated; a split scenario which divides the organization into three independent hospitals; and a corporation scenario in which corporate activities are bundled in three separate entities. PRACTICAL IMPLICATIONS In complex mergers of knowledge-driven organizations, the employees of the own organization (in addition to external consultants) might be tapped as a knowledge resource to successful future business models. ORIGINALITY/VALUE The paper uses a real world consulting case to present a new set of methods for strategic planning in large health care provider organizations.
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Affiliation(s)
- B P Geisler
- Harvard School of Public Health, Boston, Massachusetts, USA
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DeRenzo EG, Schwartz J. Building Esprit de Corps: Learning to Better Navigate between “My” Patient and “Our” Patient. THE JOURNAL OF CLINICAL ETHICS 2010. [DOI: 10.1086/jce201021308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Wartman SA. Toward a virtuous cycle: the changing face of academic health centers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:797-799. [PMID: 18728428 DOI: 10.1097/acm.0b013e318181cf8c] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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