DEPARTMENT OF MEDICINE RESEARCH RETREAT

Richard A. Walsh, MD

John H. Hord Professor

and Chairman of Medicine

Case Western Reserve University

Physician-in-Chief

University Hospitals

February 9, 2013

Case Medical Center Case School of Medicine Case Research Institute University Hospitals UH Medical Group University Hospitals at Case Medical Center is the primary affiliate of Case Western Reserve University School of Medicine.

Financing the Research Mission: the Future of Federal Funding

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“…THE MANDATE OF THE CHAIRMAN OF MEDICINE IS TO DEVELOP A BALANCED PROGRAM OF TRAINING AND RESEARCH TO ASSURE THE HIGHEST QUALITY OF PATIENT CARE IN THE BROAD FIELD OF INTERNAL MEDICINE.

…HE MUST ACCOMPLISH ALL OF THIS DESPITE SHRINKING SUPPORT FROM THE MEDICAL SCHOOL, HOSPITAL AND FEDERAL SOURCES WHILE EXPENSES ESCALATE”

Eugene Braunwald, MD 1982

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US BIOMEDICAL RESEARCH IN 2012

• 100 BILLION DOLLAR ENTERPRISE– 65% BY INDUSTRY

– 30% BY GOVERNMENT (NIH)

– 5% CHARITIES, FOUNDATIONS, INDIVIDUALS, ENDOWMENTS

• 50% OF ALL ECONOMIC GROWTH IN THE PAST CENTURY TRACED TO MEDICAL RESEARCH (MILKEN INSTITUTE)

• 30% OF RESEARCH FUNDING IN MEDICAL SCHOOLS ORIGINATES IN THE DEPARTMENT OF MEDICINE

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THE PROBLEM: THE PERFECT STORM

• NIH SUPPORT DECLINING• INDUSTRY SUPPORT DECLINING• PHILANTHROPIC SUPPORT UNDER

PRESSURE• HOSPITAL SUPPORT UNDER PRESSURE• PROFESSIONAL FEE SUPPORT

NEGLIGIBLE• ENDOWMENT INCOME RESET POST

RECESSION• PUBLIC SUPPORT AND TRUST ERODING

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FEDERAL FUNDING FOR BIOMEDICAL RESEARCH – SOME SOURCES

• NATIONAL INSTITUTES OF HEALTH• VETERAN’S ADMINISTRATION• DEFENSE ADVANCED RESEARCH

PROGRAM AGENCY (DARPA)• NATIONAL SCIENCE FOUNDATION• DIRECT CONGRESSIONAL EARMARKS• ACA RELATED PROGRAMS (eg PCORI)

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POTENTIAL SOLUTIONS: SCHOOL OF MEDICINE

• TRANSPARENCY REGARDING FUNDS FLOW TO DEPARTMENTS

• ALLOCATION OF FINANCIAL RESOURCES BY MERIT (eg INDIRECT COST RECOVERY, DEAN’S TAX, HOSPITAL SUPPORT)

• ROLE OF BASIC SCIENCE DEPARTMENTS IN THE TRIPARTITE MISSION

• PERIODIC TOP DOWN BOTTOM UP RESEARCH STRATEGIC PLAN

• PARTNER EFFECTIVELY WITH DEPARTMENTS AND CENTERS IN PHILANTHROPY AND TECH TRANSFER

• SUPPORT EXCELLENCE vs SUBSIDIZING STATUS QUO

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NIH CHALLENGES

• NIH BUDGET IS A LINE ITEM IN ANNUAL FEDERAL BUDGET/NOT AN ENTITLEMENT THUS AN EASIER TARGET FOR CUTS (UNLIKE CMS,SS)

• 10% CUT IN SALARY CAP• INCREASED EARMARKS WITHIN THE NIH

BUDGET BY CONGRESS/NIH LEADERSHIP• POST DOUBLING, POST ARRA EFFORTS• US ECONOMIC GROWTH EXPECTED TO BE 2%

OF GNP RATHER THAN 4% POST 2008 RECESSION

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POTENTIAL SOLUTIONS:DEPARTMENT OF MEDICINE

• FOCUS: THE WELL ROUNDED PERSON HAS NO POINT

• BUSINESS PLANS WITH CAREFULLY ESTIMATED RETURN ON INVESTMENT FOR RECAPITALIZING EXISTING OR NEW PROGRAMS

• INTERNAL AND EXTERNAL ADVISORY COMMITTEES WITH FOCUS ON PHILANTHROPY

• EMBRACE AND DEVELOP CENTERS/SERVICES LINES WITH DIVISION CHIEF LEADERSHIP

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It is not the strongest of the species that survives, nor the most intelligent. It is the one

that is the most adaptable to change.

~Charles Darwin

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ReducedFunding

DecentralizedData

Lack ofCollaboration

Research Mission

Retrenchment Scenario Growth Scenario

Integration of data among three missions – centralized database

Collaboration with industry and other health systems

Centers of excellence

Commercialization and brand capitalization

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