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A Word from the President: Our Readiness for Reform

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

In recent months, my conversations with many of you at AAMC meetings, campus visits, and medical society conferences always seem to converge on one topic--the changes that will come from our nation’s new health care reform law. Understandably, as we move closer to implementing the Affordable Care Act (ACA), a growing level of anxiety exists within our community about whether we will be ready for the changes that will occur. Adding to this discomfort is that many of the rules for implementing the new law have yet to be written by federal regulators.

Yet, the answer is simple. We must be ready. Our nation faces tremendous fiscal challenges fueled in large part by unsustainable increases in health care costs and spending at the federal, state, and private levels. At this critical time in our history, redesign of the health care system is no less than an economic and moral imperative for the future health of our nation.

As the places where the future of health care begins, medical schools and teaching hospitals are uniquely positioned to lead this transformation. While Congress and the president took the crucial first step to ensure that most Americans have health insurance, the true task of delivery system reform rests in our hands. As I noted in my remarks at the 2010 AAMC Annual Meeting in Washington, D.C., “we are the ones with the ability and the obligation to make the real transformation of health care happen.”

Readers of the December issue of the Reporter may recall the front-page story on the results of the AAMC’s “Readiness for Reform” survey. Sent to more than 275 members of the AAMC Council of Teaching Hospitals and Health Care Systems, and designed to be completed jointly with their medical school and faculty partners, this assessment tool is helping AAMC members gauge their readiness for reform and guide their strategy in eight domains: comparative effectiveness research, community and patient engagement, patient access, payment reform, care delivery innovation, quality reporting, health information technology, and medical education.

When I personally looked at the results, I reached two conclusions. First, while in general we currently are not fully ready for reform, many of our institutions are headed in the right direction. Second, we must be honest about our strengths and weaknesses.

Without question, we appear most ready in health IT (HIT) infrastructure and connecting this infrastructure to internal quality reporting processes. Another emerging area of strength is the importance that respondents placed on creating partnerships with local organizations to coordinate care better, as well as hiring more primary care physicians, advanced practice nurses, and physician assistants. Strengthening local partnerships and increasing our primary care services are key components of the networks we must build to provide more team-based, patient-centered care, as well as develop value-based payment models. However, when it comes to testing new models of payment and care delivery, we are less ready. Given the key element of integration that already exists in academic medical centers – a direct connection between physicians and hospitals – we should be able to make this another area of potential strength for our community. The next phase of our “Readiness for Reform” initiative will help our members conduct in-depth self-assessments of their capabilities to succeed in a transformed health care environment, as well as gauge their preparedness to participate in Healthcare Innovation Zones, Accountable Care Organizations, and other population-based delivery and payment efforts.

Our readiness for reform also must encompass our work to train the next generation by making certain our students and resident physicians have the skills they will need to practice in the new system, including an understanding of team-based care, quality improvement principles, and systems-based practice. In addition to teaching these new skills, we must include junior faculty members, resident physicians, and medical students in our institutional conversations about health care reform. If we are going to transform our health care delivery system, reform efforts must engage and involve the individuals who are going to work in that new system. Similarly, we must use our research capabilities to study the changes we make to identify effective reforms and best practices. I was very pleased to see that 62 percent of responding institutions identified comparative effectiveness research as a priority in their reform efforts.

As I travel the country, it is clear to me that significant further progress is needed at academic medical centers before we are truly ready for reform. But I am confident that, with the advancing use of information technology, our integrated networks of physicians and hospitals, our ability to shape the next generation of health care providers, and our capacity to study and disseminate effective changes and practices, medical schools and teaching hospitals are well positioned to become leaders in the transformation of our health care system. This is a critical time for our nation, and academic medical centers have both the ability and an obligation to lead the way to a better health care future.

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