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State of the Department 2011

State of the Department 2011 . Jay L. Hess M.D. Ph.D. July 27, 2011. Overview . External environment Department highlights - Clinical - Education - Research - Financial performance - Faculty New building Priorities . Overview .

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State of the Department 2011

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  1. State of the Department 2011 Jay L. Hess M.D. Ph.D. July 27, 2011

  2. Overview External environment Department highlights - Clinical - Education - Research - Financial performance - Faculty New building Priorities

  3. Overview External environment Department highlights - Clinical - Education - Research - Financial performance - Faculty New building Priorities

  4. External environment – Federal, State and Region National debt ($14.3 trillion) - Reducing growth of Medicare costs - Pressure on NIH spending (try doing the Budget Puzzle: You Fix the Budget, NYT November 13, 2011) Healthcare reform - Return to capitated payment systems/bundled payments - Increasing focus on paying for quality and outcomes - Increasing focus on patient perception of care including Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) - UMHS has submitted Pioneer ACO letter of intent

  5. External environment – Federal, State and Region 1. State - Aging population - $4 million reduction in Indirect Medical Education - Gradual but steady decrease in commercial insurance Region - Corporate closures (Borders, ?Thomson Reuters) - Ann Arbor Public Schools (62.3 teaching FTE cut, reduced bus service, etc.) Change in MI population 2000-2010

  6. External environment – UMHS • 1. Leadership:Dean and CEO reappointed for 5 year terms • Search ongoing for CIO, CFO, Head of Development, • three clinical chairs • 2. UMHS:margin: 2.66% on revenues of $2.1 billion • A negative (-1.1%) margin • is projected for FY12

  7. Merit program 2.0% Staff 3.0% Faculty

  8. External Environment: UMMS Growth in NIH funding Market Share Rank Federal Fiscal Year

  9. External Environment: North Campus Research Complex Expenditures thus far are under projections

  10. Overview External environment Department highlights - Clinical - Education - Research - Financial performance - Faculty New building Priorities

  11. Clinical Highlights 89,785 surgicals 11.3% increase over FY10 Consults +23.6% Dermpath +23.0% Placenta +26.4%

  12. Clinical Highlights: Keeping up with clinical demand

  13. Clinical Highlights New Clinical Faculty Aleodar Andea M.D. dermatopathology (molecular dermatopathology) Michael Bachman M.D. Ph.D. microbiology (molecular microbiology) May Chan M.D. dermatopathology Amer Heider M.D. pediatric pathology Alexandra Hristov M.D. dermatopathology Julie Jorns M.D. Breast pathology David Keren M.D. clinical chemistry (Associate Director Clinical Labs) Amir Lagstein M.D. GYN/pulmonary Scott Owens M.D. GI/surgical pathology Judy Pang M.D. Ph.D. breast/cytopathology

  14. Molecular diagnostics

  15. New MLabs leadership Jeffrey L. Myers M.D. A. James French Professor of Diagnostic Pathology Director of Anatomic Pathology Director of MLabs 2010 Dean’s Outstanding Clinician Award

  16. MLabs (Margin is split equally between Department and HHC)

  17. Expansion of Forensic Services Jeffrey Jentzen M.D. Autopsy and Forensic Services

  18. A new perspective on the “Ideal patient Care Experience” Service Excellence Platnum Rule “Treat others the way they would like to be treated” • Technical Excellence • Safety, quality and • personalized diagnostics • The right treatment • For the right patient • At the right time

  19. Service Excellence Pathology employee engagement survey: Room for improvement Willingness to recommend work area 63.7% We get the recognition we deserve 52.4% Easy communicating information to higher 56.2% Levels of organization My team had high employee motivation 57.1%

  20. Curriculum Development • Prepare the Leader Phases • Measurement • Completion & Early Adopter Phase • S.E. Video & Facilitator Guide • Staff Roll Out Phases • Consultation Service Excellence April 2011 - April 2013

  21. Future of Clinical Diagnostics: Personalized Medicine • What disease do I have? • Which drug(s) will it respond to? • How much drug should I take? • What are my risks of having an adverse drug reaction? • What’s my prognosis? • Increasingly the answers to these questions come from genomic information

  22. Our field is changing rapidly- High throughput sequencing (HTS) Forbes June 3, 2010

  23. Our focus: cancer diagnostics Molecularly-targeted oncology therapies are making a difference for patients High projected growth rate in new drugs and diagnostics ELM4-ALK - lung cancer (ALK inhibitors) EGFR – lung cancer (gefitinib) BRAF – melanoma (BRAF/MEK inhibitors) HER2/neu – breast cancer (trastuzamab) c-KIT – GIST (imatinib) BCR-ABL- CML (imatinib, nilotinib) Has potential to reduce costs through more selective treatment

  24. Outlook for cancer diagnostics Nature Reviews Drug Discovery 8, 279-286, 2009 Outlook: The microeconomics of personalized medicine: today's challenge and tomorrow's promise. Jerel C. Davis, Laura Furstenthal, Amar A. Desai, Troy Norris, Saumya Sutaria, Edd Fleming & Philip Ma

  25. Our strengths in sequencing-based cancer diagnostics • Michigan Center for • Translational Pathology • Top ten in NIH funding • 23.3% growth in NIH • funding in FY11 Basic Research One of top two programs in pathology informatics Pathology Informatics Research and biomarker discovery MLabs Molecular Diagnostics AP/HP Consultation 33% growth rate in FY11 14% growth in FY11

  26. Michigan Center for Translational Pathology (MCTP) Mission Establish the University of Michigan as the international leader in discovery and characterization of disease biomarkers and therapeutic targets using an integrated multi-disciplinary, systems biology approach. Establish a new paradigm of bringing personalized medicine to routine clinical care through the use of high-throughput sequencing Arul Chinnaiyan M.D. Ph.D. Director MCTP

  27. Biomarker discovery in prostate cancer ETS inhibitors/ PARP inhibitors 50-60% SPINK1 mAb/ EGFR inhibitors 10-15% RAF/MEK inhibitors 1-2%

  28. HTS-based clinical diagnostic testing Over 1000 cancer transcriptomes sequenced Results now reported back to patients as part of clinical trial Presented at 2011 ASCO Meeting

  29. Oncoseq - High throughput sequencing software

  30. Timeline from Tissue Biopsy to Sequencing Results Tumor Biopsy Sample Prep Sequence Results Pathology Sequencing Analysis Gene ALK BRAF EGFR ERBB2 PIK3CA PTEN Status WT V600E WT WT WT WT CLIA Pending Day 1 Day 2 Day 3-9 Day 19-23 Day 10-18 Day 23-30

  31. Timeline from Tissue Biopsy to Sequencing Results

  32. Personalized Oncology Through Integrative Next Generation Sequencing Tumor Biopsy >60% tumor Target X Trial: X Target Y Trial: Y Trial: Z Target Z Sequencing & Analysis Basic Research Buccal swab Discovery or Blood (germline)

  33. Molecular diagnostics milestones Milestone 1: Provide information to consented patients who are requesting information (n>10 in waiting). Funded by MCTP and PCF. Goal is to profile >100 patients. (Year 1, 3-12 months) Milestone 2: Introduce Ancillary Tests (including CTCs, urine T2-ERG, Michigan Prostate Panel (ERG, ETV1, SPINK1, RAF kinase, AMACR, p63). Funded by MCTP, Gen-Probe, Ventana/Roche, PCF (Year 1, 3-12 months) Milestone 3: Develop protocols compatible with FFPE, small/degraded samples: (Year 1, month 6 onwards) Milestone 4: Support clinical trials with high throughput sequencing. Funded by MCTP, PCF and/or drug company (Year 2 onwards) Milestone 5: Offer as a test in CLIA/CAP reference lab setting (Year 3 onwards)

  34. Business models for HTS-based diagnostics Hospitals Academic Medical Centers For profit Reference Labs • Vendor • Vendor • Cotenancy • Vendor • Joint venture University of Michigan + corporate informatics partner

  35. Education Highlights Educational office reorganization Strong performance in match New fellowships in - Pediatric Pathology - Forensic Pathology - HLA (pending) - Chemistry and Microbiology (future) Clinical Scholars Program Management training and personalized medicine Reorganization of VA rotations (thank you Dr. Chensue)

  36. Professorships: Godfrey Stobbe Professor of Pathology Education Investiture August 12, 2011 Alumni Center

  37. Research Highlights New Faculty Michael Bachman M.D. Ph.D. bacterial pathogenesis molecular microbiology Maria “Ken” Figueroa M.D. epigenetics of MDS and leukemia Jeff Rual Ph.D. high throughput proteomics

  38. Research: Department external funding 23.3% increase over FY10 IDC $150/sq ft Benchmark $110/sq ft

  39. Research administration Medical School Faculty Satisfaction Survey-Pathology 2006 2008 2010 54.8 61.3 85.7

  40. Professorships: Henry C. Bryant Professor of Pathology Lymphoma Research Foundation Featured Researcher American Society for Clinical Investigation Investiture September 15, 2011 BSRB

  41. Department Finances Major changes affecting our finances: 1. NCRC ($9.5 million over 10 years) 2. Transition to RVU-based payment system Revised Medical School Funds flow model (FAMIII) What we have done to improve our finances: Implemented professional component billing Renegotiated Professional Services Agreement (Part A) Revised MLabs agreement Expanded MLabs business Submitted and secured more grants

  42. Department Finances Total margin before market changes $7,270,253 Change in net assets with market changes $21,144,892

  43. Gerald D. Abrams Endowment

  44. Promotions Colin Duckett Ph.D. Professor Jason Gestwicki Ph.D. Associate Professor Celina Kleer Ph.D. Professor Richard Lieberman Ph.D. Associate Professor Megan Lim M.D. Ph.D. Professor Peter Lucas Ph.D. Associate Professor

  45. Farewell David Gordon M.D. Next Dean of the University of Michigan Flint School of Health Professions and Studies Reception August 3, 2011 Towsley Lobby

  46. Farewell Will G. Finn M.D. Next Medical Director of Warde Medical Laboratory Reception T.B.A.

  47. New building External environment Department highlights - Clinical - Education - Research - Financial performance - Faculty New building Priorities

  48. New building 200,000 gsf clinical laboratories Automated core lab Up to 200,000 gsf faculty offices Programming now Conceptual and schematic design 9/2011-11/2011 Design development 12/2011-2/2012 Construction document 3/2012- 9/2012 Bid and award 10/2012-12/2012 Construction 1/2013-7/2016 Activation 8/2016-9/2016 Move in 10/2016

  49. New building

  50. New building

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