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The Role of Boston University School of Medicine in Transforming Health Care . Boston University School of Medicine. Darrell G. Kirch, M.D. President and CEO, AAMC June 12, 2012. What is academic medicine’s historical legacy? . The Legacy of Abraham Flexner for Medical Education.
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The Role of Boston University School of Medicine in Transforming Health Care Boston University School of Medicine Darrell G. Kirch, M.D. President and CEO, AAMC June 12, 2012
The Legacy of James B. Wyngaarden, M.D. for Biomedical Research
The Culture of Biomedical Research Source: NIAID, 2011
Five Decades of Medical School Growth 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 hospitals • Their 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
Medical School Revenue by Source126 Fully Accredited Medical Schools, FY2010 Total Revenue: $87 B Median Revenue: $491 M Source: LCME Part I-A, Annual Financial Questionnaire, FY2010
Boston University School of MedicineRevenues by Fund Source, FY2011 Source: LCME Part I-A Annual Financial Questionnaire, FY2011
The Cauldron Grants and Contracts Physician and Hospital Revenues Tuition and Appropriations Discretionary Fund Clinical Care Education Research
…Followed by a Supreme Decision… Corbis/AP Photo/Dana Verkouteren
Eurozone's turmoil threatens global economy Euro crisis imperils recovering global economy, OECD warns —Chicago Tribune May 23, 2012 —Los Angeles Times May 22, 2012 U.S. stocks slump as Euro drops to two-year low on Greece worries —Wall Street Journal May 22, 2012
$15 Trillion is equal to: • U.S. GDP 2011 • U.S. Debt 2012 Crossing a Dangerous Line Source: http://usdebt.kleptocracy.us/
Health Care Spending Source: CMS National Health Expenditure Data, 2012
A Sobering Comparison • If 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? Data not available 0% more or gender discrimination prohibited 1 – 25% more 26 – 50% more 51 – 75% more 76 – 100% more With the Affordable Care Act Without the Affordable Care Act (starting in 2014) Based on data for what 25 year old women and men are charged for premiums. Source: National Women’s Law Center, “Turning to Fairness,” March 2012
Deficits in Access and Outcomes The risk of maternal death in high poverty areas is twice that of low-poverty areas. • In 1991, no state had an obesity rate higher than 15%. In 2010, every state did. 45 countries have lower maternal mortality ratios than the US. In 2011, health care costs increased nearly 1.5 times faster than wages. Cancer patients who receive palliative care live longer than those who don’t . 41% of adults in America had trouble finding the care they needed because of costs.
Comparing Health Care H H H Access to Care Percent of adults with insurance Prevention and Treatment Percent of older adults who receive timely preventive care Avoidable Hospital Use Number of potentially avoidable hospitalizations per 100,000 Medicare beneficiaries Health Outcomes Number of deaths per 100,000 people that could have been prevented by timely access to care 95% 2,311 71 Worcester, MA Salem, OR Boston, MA 8,773 59% Pittsburgh, PA Arlington, VA 169 26% Memphis, TN Abilene, TX 47% McAllen, TX Source: The Commonwealth Fund
Deficits in Outcomes U.S. Comparison to Developed Nations • 2009 Life Expectancy 2008 Infant Mortality 2008 Adult Obesity* • Bottom Third • 4th Highest 1st • 78.2 yrs compared to Japan at 83 • 6.5% compared to average 4.6% • Over 1/3 of U.S. population • *Only 7 nations reported data on this indicator Source: OECD Health Data 2011, June 2011
Massachusetts Health Status Massachusetts U.S. Average Life expectancy 80.1 years • 78.6 years Infant mortality rate (per 1,000 live births) 5.0 • 6.8 Heart disease rate (per 100,000) 163.8 186.5 Diabetes death rate (per 100,000) 14.5 • 21.8 Overweight/obese adults 60.1% • 63.8% • Source: statehealthfacts.org
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 American Attitudes Care Model Workforce Economic Model Institutional Culture
Rethinking Our Approach to the Medical Education Continuum Practice Residency and Fellowships Medical School Premedical
Creating a True Continuum of Medical Education Residency and Fellowships Medical School Premedical Practice
Creating a True Continuum of Medical Education Learning Residency and Fellowships Premedical Medical School Practice Assessment
Completing the Full Cycle of Research Clinical Science Discoveries Comparative Effectiveness Basic Science Discoveries Evidence-based Health Care and Prevention of Disease Patient and Community Engagement Knowledge Translation Delivery System Transformation
Transforming Academic Medicine Will Require a Different Culture
Transforming academic medicine will require a new view of excellence
The New Yorker Source: The New Yorker, February 2011
Consensus on Rankings Chronicle of Higher Education October 27, 2011
