Saving the Future of the Academic Medical Center
Recent changes to the delivery of health care, including the affordable health care act, mandates concerning cost reduction, the need for greater efficiency in patient care and new reimbursement models have driven academic medical centers (AMCs) to the edge of a precipice. They have reached a critical mass where they must restructure, reorganize and innovate or else they will almost certainly become financially unsustainable and obsolete.
How did they get here? As the health care landscape has continued to evolve, these academic institutions have remained rather stagnant, creating financial pressure and a changing environment with which they cannot keep up. If the medical community is to keep AMCs from closing or from ceasing to be academic, they must now exert enormous effort to keep them viable.
“To say AMCs are important, is to say that academic medicine is important,” says Marvin A. Konstam, MD, FACC, chair of ACC’s Academic Section. “What we’re talking about here is preserving the ability to train new physicians and other health care personnel and also continuing medical research. The motivation to keep AMCs running is present across the spectrum of health care.”
To save these important institutions, Konstam and the ACC’s Academic Section designed a mini-retreat which took place last March during ACC.15 to begin to address challenges. The goal was to spark innovative thinking and lay the ground work for how AMCs should begin to reinvent and restructure themselves to remain viable in the new health care landscape.
Open to all ACC.15 attendees, the session was divided into three main topic areas based on the components of AMCs that need restructuring: rethinking the academic medical enterprise; the structure of AMCs; and the graduate medical education program.
Starting with strategies for rethinking the academic medical enterprise, Konstam said that, “the AMC clinical value position must be strengthened to allow for greater investment in research, drive innovation and efficiency into care delivery, leverage AMC expertise in facilitating the transition in reimbursement models, and finally foster innovative academic-industry partnerships as government funding shrinks.”
In terms of restructuring of AMCs, attendees and session leaders discussed the need for the preservation and expansion of the academic mission across the expanding health delivery system, with a shift from inpatient to ambulatory services. They agreed that traditional departmental silos in AMCs must be broken down and care should be aligned across specialties. Hospitals and clinicians must also align so that health care is delivered together.
The final discussion, reevaluating graduate medical education, dealt with the evolving role of the trainee, alternative funding mechanisms, enhancing alternative educational and research funding opportunities, and improving trainee involvement in quality improvement, disease management and population management.
Armed with possible solutions to save the future of AMCs, Konstam notes the next steps will include the development of a manuscript related to this session. “I think we need to start publishing on these topics. I think we should develop new think tanks to further these ideas,” he said. “In addition, I think organizations, such as the ACC, must take on the mission of identifying best practices within AMCs and turn those institutions into models for other AMCs across the country.”
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