darrell g. kirch, m.d. president and ceo, aamc june 12, 2012

Darrell G. Kirch, M.D.President and CEO, AAMCJune 12, 2012

The Role of Boston University School of Medicine in Transforming Health Care

Boston University School of Medicine

© 2012 AAMC. May not be reproduced without permission.

What is academic medicine’s historical legacy?


The Legacy of Abraham Flexner for Medical Education


Your Own Legacy


The Culture of Education


The Legacy of James B. Wyngaarden, M.D. for Biomedical Research


The Culture of Biomedical Research

Source: NIAID, 2011


The Legacy of Lyndon B. Johnson for Health Care


The Culture of Health Care


Our institutional financial reality


Five Decades of Medical School Growth

U.S. Popula-tion

GDP in Constant Dollars

# of Physicians # of Fully Ac-credited Med-ical Schools

# of Graduates # of Full-time Basic Science

Faculty

# of Full-time Clinical Faculty

0%

200%

400%

600%

800%

1,000%

1,200%

1,400%

1,600%

70%

355%273%

56%141%

421%

1,445%

Growth in U.S. Population, GDP, and Medicine 1960-61 to 2009-10


Academia as a Major Provider of Health Care

AAMC-member teaching hospitals represent 6% of all hospitalsTheir work represents:

• 21% of all Medicare inpatient days• 28% of all Medicaid inpatient days• 38% of all hospital charity care

They provide:• 77% of all burn center beds• 39% of neonatal intensive care beds• 82% of all ACS-verified Level 1 regional trauma centers

Overall, AAMC-member teaching hospitals provide 23% of all hospital care

Source: AAMC Analysis of American Hospital Association Survey Data, FY2010


Faculty Practice Plans37%

Hospitals & Medical School

Programs16%

Other Grants & Contracts

10%

Medical School Revenue by Source126 Fully Accredited Medical Schools, FY2010

Source: LCME Part I-A, Annual Financial Questionnaire, FY2010

Total Revenue: $87 BMedian Revenue: $491 M

Faculty Practice Plans29%

Hospitals & Medical School Programs

7%

Federal Research Grants & Contracts39%

Other Grants & Con-tracts

7%

Gifts & Endowments2%

Tuition & Fees 11%

Total Revenue $567M

Boston University School of MedicineRevenues by Fund Source, FY2011

Source: LCME Part I-A Annual Financial Questionnaire, FY2011


The Cauldron

Tuition and Appropriations

Grants andContracts

Physician andHospital

Revenues

Education

Research

Clinical Care

Discretionary Fund


Our national political reality


A Bipartisan Moment…


…Followed by a Partisan Statement…


…Followed by Local Conflict…


…Followed by “Super Failure”…


…Followed by a Supreme Decision…

Corbis/AP Photo/Dana Verkouteren


…Followed by ???


Our national economic reality


Euro crisis imperils recovering global economy, OECD warns

—Los Angeles TimesMay 22, 2012

U.S. stocks slump as Euro drops to two-year low on Greece worries

—Wall Street Journal May 22, 2012

Eurozone's turmoil threatens global economy —Chicago Tribune

May 23, 2012


Crossing a Dangerous Line

Source: http://usdebt.kleptocracy.us/

$15 Trillion is equal to:• U.S. GDP 2011 • U.S. Debt 2012

http://usdebt.kleptocracy.us/


Our national health care reality


Health Care Spending

2006 2011 2016 2020

National health expenditures (trillions) $2.15 $2.71 $3.63 $4.64

National health expenditures as a percent of GDP 16.1% 17.7% 18.6% 19.8%

National health expenditures per capita $7,197 $8,648 $11,099 $13,708

Source: CMS National Health Expenditure Data, 2012


A Sobering ComparisonIf other prices had grown as quickly as health care costs since 1945…

A dozen eggs would cost

$55

A gallon of milk would cost

$48

A dozen oranges would cost

$134

Source: IOM 2011, “The Healthcare Imperative: Lowering Costs and Improving Outcomes”


49.9 Million Americans are Uninsured

That’s 16% of the total population, or the equivalent of the combined populations of 24 states.


How Much More Do Women Pay for Health Insurance?

Source: National Women’s Law Center, “Turning to Fairness,” March 2012

Data not available

0% more or gender discrimination prohibited76 – 100% more51 – 75% more26 – 50% more1 – 25% more

Without the Affordable Care Act With the Affordable Care Act(starting in 2014)

Based on data for what 25 year old women and men are charged for premiums.


Deficits in Access and OutcomesThe risk of maternal death in high poverty areas is twice that of low-poverty areas.

45 countries have lower maternal mortality ratios

than the US.

41% of adults in America had trouble finding the care they needed because of costs.

In 2011, health care costs increased nearly 1.5 times

faster than wages.

In 1991, no state had an obesity rate higher than 15%.

In 2010, every state did.

Cancer patients who receive palliative care live longer than those who don’t .


Comparing Health Care

Source: The Commonwealth Fund

H

Salem, OR2,311

Access to CarePercent of adults

with insurance

Prevention and Treatment

Percent of older adults who

receive timely preventive care

Avoidable Hospital UseNumber of potentially

avoidable hospitalizations per 100,000 Medicare

beneficiaries

Health OutcomesNumber of deaths per 100,000 people that

could have been prevented by timely

access to care

H

HPittsburgh, PA8,773

Arlington, VA59%

Memphis, TN169

McAllen, TX47%

Abilene, TX26%

Worcester, MA95%

Boston, MA71

© 2012 AAMC. May not be reproduced without permission.Source: OECD Health Data 2011, June 2011

Deficits in OutcomesU.S. Comparison to Developed Nations

*Only 7 nations reported data on this indicator

Bottom Third

78.2 yrs compared to Japan at 83

4th Highest 1st

6.5% compared to average 4.6%

Over 1/3 of U.S. population

2009 Life Expectancy

2008 Adult Obesity*

2008 Infant Mortality


Massachusetts Health Status

Source: statehealthfacts.org

Massachusetts U.S. AverageLife expectancy

Infant mortality rate (per 1,000 live births)

Heart disease rate (per 100,000)

Diabetes death rate (per 100,000)

Overweight/obese adults

78.6 years

6.8

21.8

63.8%

5.0

80.1 years

163.8 186.5

14.5

60.1%


Boston, MA Health Status

Source: Commonwealth Fund Scorecard on Local Health System Performance, 2012


Boston, MA Health Status

Source: County Health Rankings & Roadmaps, Robert Wood Johnson Foundation, 2012


In the face of these realities, what future should academic medicine seek to create?


Creating a “True” Health Care System

Care Model

Workforce

Economic Model

American Attitudes

Institutional Culture


Rethinking Our Approach to the Medical Education Continuum

Premedical

Medical School

Residency and Fellowships

Practice


Premedical Medical SchoolResidency and

Fellowships Practice

Creating a True Continuum of Medical Education


Creating a True Continuum of Medical Education

Premedical Medical School Residency and Fellowships Practice

Learning

Assessment


Completing the Full Cycle of Research

Evidence-based Health Care and

Prevention of Disease

Basic Science Discoveries

Clinical Science Discoveries

Comparative Effectiveness

Patient and Community Engagement

Delivery System

Transformation

KnowledgeTranslation


Transforming Academic Medicine Will Require a Different Culture

Collaborative

Team-based

Service-based

Mutually Accountable

Patient-centered

Hierarchical

Autonomous

Competitive

Individualistic

Expert-centered


Transforming academic medicine will require a new view of excellence


The Rankings


Consensus on Rankings

Chronicle of Higher Education October 27, 2011


The Excellence Around Us


“Old Excellence”

Rankings

Size, growth

Mean MCAT® exam scores

Number of full-time faculty

Research funding

Hospital volume

“New Excellence"Toward a New Excellence

Institutional mission

Serving the community

Students attributes

Educational quality

Research outcomes

Wellness and prevention


How is Boston University demonstrating the new excellence?


BU Cares


Service Learning

VA Boston Healthcare System


International Collaboration

darrell g. kirch, m.d. president and ceo, aamc june 12, 2012

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