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At least 19 recordsLinked to original sources
PubMed1989

The economic impact and multiplier effect of a family practice clinic on an academic medical center.

Academic medical centers are facing the need to expand their primary care referral base in an increasingly competitive medical environment. This study describes the medical care provided during a 1-year period to 6304 patients registered with a family practice clinic located in an academic medical center. The relative distribution of primary care, secondary referrals, inpatient admissions, and their associated costs are presented. The multiplier effect of the primary care clinic on the academic medical center was substantial. For every $1 billed for ambulatory primary care, there was $6.40 billed elsewhere in the system. Each full-time equivalent family physician generated a calculated sum of $784,752 in direct, billed charges for the hospital and $241,276 in professional fees for the other specialty consultants. The cost of supporting a primary care clinic is likely to be more than offset by the revenues generated from the use of hospital and referral services by patients who received care in the primary care setting.

Age Factors↗
PubMed2000

Establishing a pediatric hospitalist program at an Academic Medical Center.

Academic medical centers have been challenged to respond to a rapidly changing and increasingly competitive health care environment. The Pediatric Consultation and Referral Service (PCRS) at Rainbow Babies & Children's Hospital (RB&C)/University Hospitals of Cleveland was established in 1993 with the goal of providing rapid access to community-based physicians for the referral of patients requiring urgent hospitalization within the broad scope of general pediatrics. We describe our initial 3-year experience in the planning, implementation, and evaluation of a pediatric hospitalist program. PCRS provided care to 2,740 patients during the first 3 years of operation, 63% (1,716) of whom were under age 3 years. Leading primary diagnoses in order of decreasing frequency were asthma, pneumonia, bronchiolitis, febrile illness, gastroenteritis, seizures, croup, apnea, and cellulitis. Third-party payer mix was: Medicaid 42%, managed care 42%, indemnity insurance 10%, self-pay 6%, and Bureau for Children with Medical Handicaps 1%. From survey data, referring physicians and pediatric residents assessed perceptions of access, collegiality, and quality of care in a highly favorable manner. Subspecialty colleagues perceived access and collegiality very favorably but rated quality of care substantially lower than referring physicians and residents did. Our experience demonstrates that a pediatric hospitalist program is logistically and economically feasible and may contribute to the patient care, education, and research missions of academic medical centers. A well-structured program can provide community physicians with excellent access and support collegial relationships. Beyond increasing a medical center's patient referral base, a hospitalist program can potentially enhance the esteem of the discipline of general pediatrics and, it is hoped, promote general pediatrics as a viable career option for trainees.

Academic Medical Centers↗
PubMed1989

Future role of academic medical centers.

Academic medical centers face many future challenges; success will not come as easily as it has in the past. Building on strengths of the past, as well as reorganizing to address emerging issues, will be the keys to success.

Academic Medical Centers↗
PubMed2005

Making a home in the community for the academic medical center.

Academic medical centers (AMCs) have traditionally provided primary care for low-income and other underserved populations. However, they have had difficulty developing lasting partnerships with other organizations serving the same populations. This article describes an exception to the rule, in which an academic division was created at Duke University Medical Center to develop effective collaborations with health care and social service providers in Durham, North Carolina, including both public agencies and private organizations. Together, the division and its partners have created and operate programs that improve health outcomes and access to care for those at risk. These programs share a number of characteristics: they are designed to meet the needs of the patient, not the provider; they are based in the community, not in the AMC; they bring services to people's homes, schools, and neighborhoods; they are multidisciplinary, combining health, social, and even mental health services; and, once established, they are revenue-generating and can be made self-supporting when grant funding ends. These programs are also innovative. They are designed to model and test new ways of organizing and delivering care. Preliminary indications suggest that they also strengthen the AMC's relationships with the surrounding community.

Academic Medical Centers↗
PubMed2001

A process for reducing workload and enhancing residents' education at an academic medical center.

Academic medical centers are under increasing pressure to find alternatives to residents for the provision of patient care and to expand and improve the educational opportunities for residents. To address these concerns, the authors performed a study of the medical wards at Harborview Medical Center, a county-owned medical center managed by the University of Washington School of Medicine. Admitting diagnoses, provider names, and billings were obtained from professional practice plan billing records. Based on the distribution of admitting diagnoses, a subset of patients was identified that could be removed from routine care by residents and could instead be cared for by non-physician providers (i.e., physician assistants and nurse practitioners) using clinical pathways. The cohort was large enough to reduce the number of patients per resident to within national accreditation guidelines, and to provide faculty with more time available for teaching. The authors summarize the approach used to identify the new model for care delivery indicated above and the plans made to implement that model and to analyze its impact on the quality of patient care, hospital costs, residents' education, and the process of implementing change. The authors conclude that solutions to the problems of workload and education that they confronted will vary by department and hospital setting. Yet a systematic approach to discovering solutions, such as they present, can be adapted to any setting.

Academic Medical Centers↗
PubMed1994

May you live in interesting times. Academic medical centers, academic societies, and the coming dominance of government and business in American medicine.

The coming changes in the organization and financing of medicine will lead to dominance of government and business in the American health care system. These changes will have a profound effect on academic medical centers (AMCs). To compete for managed care contracts and maintain their patient bases, AMCs will have to compete with private providers on cost, something they are ill-equipped to do because of their high cost structures. The AMCs are likely to have lower patient care revenues and alter the makeup of their faculties to reduce the number of specialists and increase the number of primary care physicians. Undergraduate and graduate medical education and research are also likely to suffer adverse consequences as a result of these changes. With the number of specialist residency positions decreased, it will be difficult for faculty to replace residents with physicians' assistants or nurse clinicians. Faculty may have to devote more time to patient care, and research and education may suffer. The decreased revenues of AMCs will affect the Surgical Infection Society and other academic societies. Society members may limit the number of societies to which they belong as their incomes or those of their departments are threatened.

Academic Medical Centers↗
PubMed2006

Geriatric medicine and geriatric psychiatry clinical services affiliated with U.S. academic medical centers.

U.S. academic medical centers are providing many geriatric medicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non-VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non-VHA GM and GP services, affiliation with 21 Programs of All-Inclusive Care for the Elderly, and 12 other specialized services. The mean number+/-standard deviation of distinct clinical services at each medical center was 16.4+/-8.2. More geriatrics faculty full-time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu).

Academic Medical Centers↗
PubMed1984

Impact of the evolution in health care delivery on the academic medical center.

The academic medical center is currently being affected by major changes in the national health care delivery system. These changes include the rapid growth in prepaid health plans, the emerging surplus of physicians, and the continued escalation of health care costs. The potential effects of these changes are only now becoming appreciated and may have significant ramifications for the entire medical education system. In this article, the author traces the impact of these changes on one major academic medical center. He presents a methodology for pinpointing other centers that may soon be affected and discusses ways to minimize the undesirable consequences of these changes.

Academic Medical Centers↗
PubMed1995

Managed care: competitive strategies for academic medical centers.

For academic medical centers to get from where they are to where they need to be, their traditional clinical services paradigm must change in a frame-breaking, re-engineered, revolutionary way. The change must be real, as the market place will recognize impostors, and it must be led by a strongly committed executive leadership team. This professional paper will show that once accomplished, academic medical centers will most likely acquire the "competitive advantage" needed to win their rightful position in the future health care marketplace.

Academic Medical Centers↗
PubMed2006

An Intranet-based system for inpatient billing in an academic medical center.

Academic physicians face great economic challenges. There is therefore a growing need to increase the efficiency of academic practice. One potential target for improving the "business" of medicine is inpatient billing. Currently many academic centers use "yellow" cards for inpatient billing. This is an inefficient system for capturing patient charges. We describe an Intranet-based system for inpatient billing that improves physician "productivity," reduces billing lag time, and increases the collection rate and total revenues.

Academic Medical Centers↗
PubMed1999

Taking a corporate approach to information technology in an academic medical center.

Academic health science centers employ faculty and research staff who demand and merit a high level of information technology (IT) support. Often their needs outstrip the ability of IT to provide adequate service. The authors review the recent history of IT at Baylor College of Medicine, beginning with the critical review of its operations undertaken outside consultants in 1996. The analysis led to a strategic planning strategic planning retreat at which three infrastructure projects and three systems projects were identified. As the IT program executed these projects, it transformed itself into a more modern organization able to provide higher levels of service to faculty and staff. Those involved in these changes at Baylor were able to successfully adopt a corporate model of information services support without sacrificing the college's academic focus.

Academic Medical Centers↗
PubMed2002

Professionalism and justice: ethical management guidelines for leaders of academic medical centers.

Academic health centers (AHCs) exist for the sake of pursuit of excellence in their missions of patient care, teaching, and research. Survival should be a means to these goals and not an end unto itself. Because of the fiscal crisis in health care, leaders of AHCs face the possible diminution or even extinction of their centers. When preventing such a fate becomes the governing concern of these leaders, power concentrates in their hands and can be used to force cooperation among competing faculty members and groups for the sake of mutual survival. The ethical concepts of professionalism and justice can be used to create a vital, practical, alternative vision for the leadership of AHCs, in which their missions once again become central to their organizational culture. Creating a morally sustainable organizational culture of professionalism and justice should rely not on forced cooperation, but on voluntary cooperation of all stakeholders in the pursuit of a common goal-professional excellence in patient care, teaching, and research-with survival understood to be a means to this goal. To achieve this alternative vision, the authors propose five management guidelines. For example, all faculty should be made accountable not only for maximizing the good of the organization's professionalism but also for fostering financial viability.

Academic Medical Centers↗
PubMed1996

Reengineering academic medical centers: reengineering academic values?

Academic medicine is entering an era of profound, unsettling change resulting not simply from the drastic transformation of the health care marketplace but more fundamentally from the chronic, growing gap between academic medicine's seemingly insatiable demand for total resources and the supply of resources that society is willing to provide. To examine this problem, the author reviews the major factors that have shaped the development of academic medical centers (AMCs) since World War II and are now the roots of their vulnerability. The first was the major federal investment in university-based programs of science research and education that began in the 1940s; the second was the enactment in the 1960s of the Medicare/Medicaid legislation that established federal responsibility for the support of graduate medical education. After describing important characteristics (e.g., number of faculty, number of students, dollars spent on research) of the growth and accomplishment that resulted from this massive infusion of federal funds over the last few decades, the author discusses several adverse consequences, such as the de-emphasis on education in favor of research and clinical service delivery and the serious disjunction between the internal labor markets of the AMCs and the external labor markets of the real world that AMCs' graduates enter. The author then analyzes the severe challenges being faced by academic medicine in research, education, and clinical practice in the emerging resource-limited environment. Of particular concern are the fate of the clinical investigator and the future of clinical research. The author concludes with a list of four feasible strategic options for AMCs (e.g., "build one's own system") and an extensive list of what he believes AMCs will do to respond to the stresses now upon them (e.g., capitalize on unique strengths rather than trying to compete in all areas). He concludes that it will take courage for AMCs to preserve their core values in the new era, but that this can be done if AMCs craft new adaptive structures that are better attuned to the new environment and not wedded to one that is vanishing.

Academic Medical Centers↗