AAMC Reporter: May 2009

A Word from the President: "Academic Medicine and the 'First 100 Days'"

By now, I imagine you have seen numerous "First 100 Days" news stories about the Obama presidency. This journalistic benchmark, which began as a way to chronicle the New Deal under President Franklin Delano Roosevelt, has evolved in recent years as a means to characterize a presidency based on early actions. I certainly do not intend to provide another sweeping "instant analysis" of President Obama. Instead, I would like to focus on what we, as the academic medicine community, can learn at this early stage about our relationship with the new president.

The very promising news is that the Obama administration clearly appreciates that academic medical centers can and should be at the forefront of innovation in our health care system. This support for our work was reinforced when I joined a small group of other health care leaders in March to meet with White House staff. Today, as I reflect upon a very interesting and productive discussion, that meeting seems emblematic of the clearly positive signs that have emerged for each of our mission areas these past 100 days.

For example, less than a month after President Obama took the oath of office, we saw two "early victories" in patient care. The first was reauthorization and expansion of the Children's Health Insurance Program (CHIP). Passed by Congress and quickly signed by President Obama, the legislation not only extended funding for this important program until 2013, but also expanded eligibility to include an estimated 4.1 million additional low-income, uninsured children. A substantial level of support for another key source of funding for teaching hospitals, capital Medicare indirect medical education (IME) payments, was restored soon after that when the president signed the American Recovery and Reinvestment Act (ARRA). Without this provision, a scheduled 50 percent cut in payments would have meant $191 million less in vital support for teaching hospitals.

As to the broader issue of health care reform, the president's commitment to large-scale change in key ways aligns with our vision. For example, the core principles guiding the administration's health care efforts announced in February adhere closely to the six principles the AAMC and its membership developed last fall (see New Models for Care Delivery). In releasing his (topline) FY 2010 budget proposal, which includes $634 billion for health care reform over the next decade, the president also took several steps to develop an infrastructure for health system change. In addition to choosing a close advisor, Nancy-Ann DeParle, to head the newly established White House Office of Health Reform, President Obama reached out to the ranks of academic medicine by appointing David Blumenthal, M.D., M.P.P., most recently head of the Institute for Health Policy at Massachusetts General Hospital/Partners Healthcare System, to be national coordinator for health information technology.

Additionally, academic medicine has been well represented in the several regional health care summits being held nationwide, and we thank our constituents who participated in these discussions.

In a similar manner, President Obama has shown strong support for and appreciation of the role research plays in disease prevention and in improving the health of Americans. The changed environment for public support of science is palpable. One highly visible statement is the $10.4 billion for National Institutes of Health (NIH)-funded research included in the ARRA. However, we must remain mindful that this is a twoyear investment and of the crucial need to sustain investment in research over the long term. As the FY 2010 appropriations process goes forward, we hope that this commitment to research is maintained.

Turning to education, both through leadership and funding decisions, it appears that the president also shares our vision of a robust, health professions workforce. Mary Wakefield, Ph.D., R.N., a strong supporter of workforce issues, was tapped to head the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS). As she takes the helm, Dr. Wakefield has the benefit (through ARRA) of $300 million to help strengthen the National Health Services Corp and $200 million for health professions funding through Titles VII and VIII. This is welcome relief for key programs that have seen dramatic funding cuts in recent years.

While these actions bode well for our relationship with this new president, much work lies ahead. In fact, in coming days, we will be enlisting your support on many fronts—from helping us work toward long-term, sustained investment in NIH research during the FY 2010 budget process, to participating in upcoming regional health care summits.

We also will be talking with you about new approaches to health care delivery and opportunities for academic medicine to partner with key stakeholders. For example, the AAMC is now working to develop specific proposals for President Obama and HHS Secretary Kathleen Sebelius regarding ways in which our member institutions, in partnership with others, can become testing sites for broad-scale innovations. We also are educating Congress and the administration about the important role academic medicine plays in communities in forwarding ideas for health reform. To that end, we held a Capitol Hill briefing last month on graduate medical education that was widely attended. Additionally, we have been working with congressional staff charged with writing health care legislation to help represent the views of academic medicine as they work to address cost, quality, and access.

Just as 100 days cannot define a presidency, nor can it guarantee that our interests in patient care, research, and education remain at the forefront. Like President Obama, we are only beginning our efforts to advance the nation's health, and I encourage you to stay engaged and involved.

Darrell G. Kirch, M.D., AAMC President and CEO