Back to Front PageVOLUME 6, NUMBER 4
 

Michael M.E. Johns. M.D., is executive vice president for health affairs at Emory University

Academic medical centers continue to operate on precarious, shifting terrain. While most of our centers have strong programs of education, research, and patient care, we all feel increasing pressure to reduce costs and to compete with the private players in clinical care and many areas of research.

We remain vulnerable to even the slightest changes in reimbursement, patient demographics, payor reimbursement schedules, new competitors in specialized fields, and the ebb and flow of support from NIH, NSF, and the philanthropic sector.

The bottom line is that academic medical center leadership must do everything we can to protect and enhance the academic mission. Without that, without the absolute commitment to being centers of inquiry, education, and discovery, we are-or will be-nothing special.

This means, first of all, that we need to be hard-nosed about budgeting across the board. We must know how our costs are generated and where our revenues, service costs, and productivity issues are. Without this information and without rational planning based on it, we cannot work effectively in this new environment. And physicians must be a part of this effort. But belt-tightening alone isn't enough: We all need capital-new money to invest not only in research and educational programs but also in infrastructure, facilities, expanded information systems capabilities, and faculty and staff.

One major answer we have found is strategic partnering. For example, two years ago, Emory penned a deal with Columbia/HCA (now HCA - The Healthcare Company). Unlike some other academic medical centers' relationships with the hospital chain, Emory's is an equal partnership. We didn't put out a nickel and they didn't acquire a thing of ours: not a hospital, physician group, or anything else.

We got access to their eight community hospitals and other community care centers in our region. They got access to our reputation for the finest care and to the comprehensive services that we provide. And we got a partner with whom new projects can be floated and joint ventures can be created.

And whether payors like it or not, academic medical centers need to forge partnerships with them. We should be working together with payors to reduce costs and increase efficiencies. We need to see our missions as complementary and overlapping and then act accordingly. This is absolutely key to our future.

Other important areas for increasing funding are efforts in technology transfer and in entrepreneurial activity among faculty. Patenting and licensing of new technologies can become a serious source of revenues-institutional, individual, and departmental. In addition, establishing and incubating biotech companies can provide incredible opportunities across an institution and beyond. These should be priorities in all academic medical centers.

Another priority must be the philanthropic sector. Emory has benefited greatly from patients, industrialists, and philanthropists. The Foundation Center, which tracks trends in foundation giving, reported that health care and research grants have increased in recent years to 17 percent of all private foundation giving, putting health care in second place behind education.

We also need to be more active in our local communities by taking leadership positions and serving as local and regional information resources. It's absolutely critical to realize that our communities and our patients are our most important and enduring allies. We should be doing everything we can to reinforce that alliance and to build on it.

A key element in this community focus is providing health information and education to patients and the community at large. There is now an enormous flow of health information directed to the consumer. Health information and advertising are provided on countless Web sites as well as in print, radio, and television.

With so much information out there, consumers are struggling to identify sources they can trust to give them the best information. Academic medical centers should be that source. Marketing research at Emory suggests strongly that community members look to academic health centers for reliable health and medical information more than they look to other sources.

That's why medical centers ought to actively sponsor Web sites and other forms of timely and accurate information for community and patient use. If done right, these new resources will become important catalysts of increased community and philanthropic support.

Last, but certainly not least, we need to spend much more time and resources preparing people for leadership in this new environment. Division heads and department chairs need to understand the tools and imperatives of leadership, and that leadership means more than good research. We all need to initiate programs to create, enhance, and improve the leadership we need for the future.

We can take powerful steps to reassert our critical roles, our expertise, and our proper place at the forefront of defining the future of health care. The power to determine our own destiny rests on our capacities to innovate and think our way through these difficult, but far-from-impossible, challenges.

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