Task Force Urges Reengineering Of Nation's Teaching Hospitals And Medical Schools

Washington, D.C., February 4, 2003—The Commonwealth Fund Task Force on Academic Health Centers today presented a blueprint for the future of the nation's teaching hospitals and medical schools, recommending sweeping changes in clinical practice, research, and education at a time when they are critical to the nation's well-being. The Task Force, which has been studying this issue for seven years, called on teaching hospitals and their affiliated medical schools—known as academic health centers (AHCs)—to rationalize their financial management, take advantage of new technologies in education, and demonstrate greater accountability for what they do. The Task Force also made public policy recommendations that could ensure the survival of academic medicine's vital missions. The Task Force says that some AHCs are finding it more difficult to survive in the current health care environment, which is becoming both increasingly complex and constrained by rising costs. The Task Force's report, Envisioning the Future of Academic Health Centers, contains more than two dozen recommendations aimed at modernizing and improving the functioning of AHCs. "The missions of academic health centers are essential to maximizing public health in the United States," said David Blumenthal, M.D., executive director of the Task Force and director of the Institute for Health Policy at Massachusetts General Hospital/Partners HealthCare. "But AHCs must be able to meet the evolving needs of the American people. They will have to learn quickly, act expeditiously, and face change head-on." The report, Envisioning the Future of Academic Health Centers, also cautions that future funding of AHCs is at risk. In addition to the pressures caused by spiraling health care costs and rising numbers of uninsured, Medicare reforms under consideration by the Bush administration could seriously affect future funding for AHCs, which rely heavily on Medicare for financial support. The Task Force proposes the creation of a public trust fund to provide monies explicitly to support vital AHC missions. Doing so will make the financing more accountable, predictable, and transparent. West and South In Need of More AHCs
To meet the country's projected health care needs, the national capacity to perform research, teaching clinical innovation, and highly specialized and indigent care—all functions currently performed by AHCs—must increase over time, the Task Force says. That does not necessarily mean that the number of AHCs should be expanded, if other types of organizations can perform those functions. However, the Task Force notes, any growth in AHC capacity should be focused first in the West and the South, which have experienced significant population increases and where there is a dearth of medical schools. The Task Force's blueprint encourages AHCs to think and act more strategically. On a broad level, they should be more responsive to the needs of the communities they serve. In addition, they should dramatically improve their internal accounting and financial management abilities. They should also develop capabilities for performance measurement and improvement, the Task Force recommends. In the future, most AHCs will specialize in certain missions; few will attempt proficiency in all areas of research, education, and clinical care, the Task Force predicts. They will seek balance and diversification among the areas they pursue and chart their long-term agendas strategically. Interdisciplinary work will be the norm, especially in research. Following are some of the Task Force's recommendations in key areas. Research. The Task Force urges AHCs to bring university-based research and innovation into the mainstream of American health care delivery. Among the Task Force's specific recommendations, AHCs should:

• Become centers of research innovation by giving higher priority and recognition to new and traditionally undersupported areas of biomedical science.
• Focus on translating the results of clinical research into everyday practice.
• Nurture and manage their research relationships with industry in a manner that promotes the public interest, protects patient participants, and maintains academic values.

Education. AHCs should incorporate training in leadership, team-building, continuous improvement, and measurement of clinical performance into their basic education curricula. They should be open to training new types of health professionals to meet changing health care needs. In addition, the Task Force recommends that AHCs:

• Develop capabilities to educate students, residents, and clinicians online and remotely.
• Incorporate simulation in all levels of experience, from students' first encounters with clinical care to continuing education and certification of master clinicians.
• Provide leadership in training a culturally competent clinical and research workforce.

Clinical Services. Most AHCs will focus on providing high-technology and specialized services, the Task Force predicts, although some will specialize in primary and community-based services. Regardless of their focus, the Task Force recommends that AHCs develop relationships with other organizations—academic and non-academic—that will help them provide optimal care and ensure that trainees have the clinical exposures they need. AHCs should also:

• Work to improve the safety, quality, and efficiency of the services they provide as part of a continual performance improvement process.
• Act decisively to improve outcomes that fall below those obtained by peer institutions—or discontinue those clinical services.
• Become leaders in applying information technology to improve health care.

Care for the Indigent. The Task Force urges AHCs to maintain their strong commitment to the care of the poor and underserved. To that end, they should:

• Ensure that the quality and efficiency of care provided vulnerable populations are comparable to that available to other populations.
• Work with partners in local communities to serve the needs of poor and indigent patients.
• Adopt explicit programs to train staff at all levels to provide care that is culturally appropriate and responsive to the diverse needs of ethnically and racially varied populations.

"Academic health centers have prided themselves on providing much-needed leadership in the health community," said Joel Weissman, Task Force project director. "Now, that leadership takes on a new meaning, requiring AHCs not only to pioneer new clinical technologies and provide state-of-the-art care, areas in which they have traditionally excelled, but also to implement new methods for organizing and financing care. They can and will rise to that challenge." "It is essential that academic health centers—the leaders in providing education to our country's health professionals, essential specialty care to our population, research to bring us a healthier future, and care for the less affluent people in this country—continue to focus on these missions, and have the financial security to be able to achieve them," said Stephen C. Schoenbaum, M.D., senior vice president at The Commonwealth Fund. "Since our nation's health and security depend on them, AHCs must be accountable to the American people for accomplishing these missions." Envisioning the Future of Academic Health Centers is the sixth and final in a series of major reports generated by the Task Force. The first report, Leveling the Playing Field, noted the effects of competitive health care markets on the organizational and financial underpinnings of the AHC enterprise. From Bench to Bedside examined the status of AHCs' research mission; Health Care at the Cutting Edge explored the crucial role AHCs play in the development and delivery of highly specialized, technologically complex medical services; A Shared Responsibility documented the contributions of AHCs in providing medical care to indigent and uninsured patients; and Training Tomorrow's Doctors detailed the problems and challenges AHCs face in educating the nation's health care workforce. The Commonwealth Fund Task Force on Academic Health Centers was formed to examine the problems facing AHCs in the changing health care environment. Specifically, the Task Force has examined how AHCs can continue to pursue their social and academic missions of providing medical education, performing biomedical research, supplying specialized services, and providing indigent care.