Academic Medical Centers: Too Large for Their Own Health?

[radiation]

Academic Medical Centers—Too Large for Their Own Good?

This Viewpoint discusses the conflict between the role of academic medical centers as providers of complex uncompensated care, and the large profit margins they realize from expensive fee-for-service clinical activity that puts them at odds with attempts to reorganize medicine to provide...

jamanetwork.com

Insightful commentary. Rad onc has become a microcosm of this right here:

Thus, many of today’s AMCs are similar to huge tankers loaded with health care services, and research and education are merely passengers. The growth of the clinical enterprise has allowed academic medicine to maintain its research and education missions in the face of relatively stagnant funding for research from the NIH, and limited core support from state and federal governments, particularly when inflation is considered. In fact, the margins on clinical revenues are often used to cover deficits in budgets for research and education and from providing subsidized care. There is the crux of the issue: any changes threatening the margins from clinical care will affect the entire mission of an AMC. The AMC missions are not self-funded; the margins on clinical care are required at most AMCs as is philanthropy.

Clinical activities at AMCs are predominated by tertiary care and by fee-for-service medicine. In 1998, the average cost of care at teaching hospitals was estimated to be 44% greater than at community hospitals7 and elevated costs have persisted.8 Academic medical centers tend to do well in negotiating reimbursement rates from insurers, and they tend to admit patients who require more expensive and invasive interventions. Academic medical centers are optimized to deliver financial results in the prevailing fee-for-service system.

Thus, by necessity, the majority of AMCs are inclined to stay the course of the current health care system. A move to value-based care is more than just risky; it is counter to their best interests unless a clear line of sight to new payment models exists. In the fee-for-service payment system, preventing illness and reducing wasteful diagnostics or unnecessary treatments could reduce the income of AMCs (as well as other medical centers). Although many reports that have described the need to reallocate resources toward prevention, population health, and value-based care come from medical school faculty, the leaders of the AMC clinical enterprise will tend to resist change because it puts the entire institution at risk. Faculty can discuss population health and value, but may be stymied from making important progress. In this way, academic medicine is not fully aligned with society’s interest in optimizing health outcomes or in reducing waste.

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[OTN]

In yet another microcosm, meanwhile in the Red Journal academicians continue to push for protons:

https://www.redjournal.org/article/S0360-3016(19)30628-5/fulltext

https://www.redjournal.org/article/S0360-3016(19)30372-4/fulltext

 

[Neuronix]

Here's everything you need to know in two figures.

 

[seper]

There is quite a bit of difference between doing RadOnc at a hospital chain vs. a university hospital. In some markets the difference is blurred, but not always..

 

[medgator]

Here's everything you need to know in two figures.


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Was true several years ago too

Medicine’s Top Earners Are Not the M.D.s (Published 2014)

Overseeing the business of medicine is big business.

www.nytimes.com

 

[Irradi8or]

Not exactly related, but even big well known centers can get into big problems:

MD Anderson patient died after getting contaminated blood

The event that triggered increased government oversight of MD Anderson Cancer Center was...

www.houstonchronicle.com

 

[evilbooyaa]

Not exactly related, but even big well known centers can get into big problems:

MD Anderson patient died after getting contaminated blood

The event that triggered increased government oversight of MD Anderson Cancer Center was...

www.houstonchronicle.com

3rd SCT for ALL? My goodness. That poor patient was dead regardless of the situation.

 

[deleted941485]

3rd SCT for ALL? My goodness. That poor patient was dead regardless of the situation.

3 SCTs and yet we are the evils ones lol.

 

[deleted947887]

In the last year, headlines have been made by the largest oncology academic centers (not in a good way). These academic centers are proving to be a danger to society. The FBI should be investigating these organizations IMO.

Memorial Sloan Kettering Leaders Violated Conflict-of-Interest Rules, Report Finds (Published 2019)

A policy review follows months of turmoil at the cancer center, which pledged an overhaul, including new rules on public disclosure and limits on outside profits.

www.google.com

MD Anderson patient died after getting contaminated blood

The event that triggered increased government oversight of MD Anderson Cancer Center was...

www.houstonchronicle.com

An insurer denied her $95,000 cancer treatment. She’s fighting back - The Boston Globe

Kate Weissman’s lawsuit pending in federal court has put a spotlight on a potentially promising but very costly form of radiation treatment using protons.

www.google.com

[...]Eventually, her parents, who live in Philadelphia, called with a question: How much would the treatment cost? In May 2016, they wired $95,000 to Mass. General, and Weissman began proton therapy a few days later.

She teared up as she recalled her parents’ sacrifice. “I was grateful and devastated at the same time,” she said.

Weissman said hospital officials later refunded her parents $40,000, without providing an explanation.[...]

 

[thecarbonionangle]

In the last year, headlines have been made by the largest oncology academic centers (not in a good way). These academic centers are proving to be a danger to society. The FBI should be investigating these organizations IMO.

Memorial Sloan Kettering Leaders Violated Conflict-of-Interest Rules, Report Finds (Published 2019)

A policy review follows months of turmoil at the cancer center, which pledged an overhaul, including new rules on public disclosure and limits on outside profits.

www.google.com

MD Anderson patient died after getting contaminated blood

The event that triggered increased government oversight of MD Anderson Cancer Center was...

www.houstonchronicle.com

An insurer denied her $95,000 cancer treatment. She’s fighting back - The Boston Globe

Kate Weissman’s lawsuit pending in federal court has put a spotlight on a potentially promising but very costly form of radiation treatment using protons.

www.google.com

[...]Eventually, her parents, who live in Philadelphia, called with a question: How much would the treatment cost? In May 2016, they wired $95,000 to Mass. General, and Weissman began proton therapy a few days later.

She teared up as she recalled her parents’ sacrifice. “I was grateful and devastated at the same time,” she said.

Weissman said hospital officials later refunded her parents $40,000, without providing an explanation.[...]

“There’s the right way and then theres the anderson way!!”

 

[scarbrtj]

Here's everything you need to know in two figures.


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Could be wrong but I don't see a single non-white or woman on this list.
EDIT: By the by, Romoff (UPMC) is this guy right here. Also his favorite saying is "Hate the game not the player."
EDIT2: And just remember as much as we all LOVE to complain, it's all our (the doctors', yes) fault.

 

[scarbrtj]

Eventually, her parents, who live in Philadelphia, called with a question: How much would the treatment cost? In May 2016, they wired $95,000 to Mass. General, and Weissman began proton therapy a few days later.

Trouble with the bill? Pay me!

 

[Neuronix]

Could be wrong but I don't see a single non-white or woman on this list.

They do appear to be all male. I didn't review all of them, but #1 on the list is African American.

 

[deleted941485]

In the last year, headlines have been made by the largest oncology academic centers (not in a good way). These academic centers are proving to be a danger to society. The FBI should be investigating these organizations IMO.

Memorial Sloan Kettering Leaders Violated Conflict-of-Interest Rules, Report Finds (Published 2019)

A policy review follows months of turmoil at the cancer center, which pledged an overhaul, including new rules on public disclosure and limits on outside profits.

www.google.com

MD Anderson patient died after getting contaminated blood

The event that triggered increased government oversight of MD Anderson Cancer Center was...

www.houstonchronicle.com

An insurer denied her $95,000 cancer treatment. She’s fighting back - The Boston Globe

Kate Weissman’s lawsuit pending in federal court has put a spotlight on a potentially promising but very costly form of radiation treatment using protons.

www.google.com

[...]Eventually, her parents, who live in Philadelphia, called with a question: How much would the treatment cost? In May 2016, they wired $95,000 to Mass. General, and Weissman began proton therapy a few days later.

She teared up as she recalled her parents’ sacrifice. “I was grateful and devastated at the same time,” she said.

Weissman said hospital officials later refunded her parents $40,000, without providing an explanation.[...]

I resent the fact that smaller hospitals basically invoke their names on the building in order to attract patients and pay place like MDA money for the privilege of doing so. If they only knew how downright sleezy organizations like this can be maybe they would think twice before forming over millions of dollars for a name

 

[Irradi8or]

I resent the fact that smaller hospitals basically invoke their names on the building in order to attract patients and pay place like MDA money for the privilege of doing so. If they only knew how downright sleezy organizations like this can be maybe they would think twice before forming over millions of dollars for a name

In this healthcare environment not sure how long such a setup can last:

Summit Medical Group ends relationship with MD Anderson | ROI-NJ

Summit Medical Group has ended its relationship with MD Anderson, ROI-NJ has learned. Summit CEO Dr. Jeffrey LeBenger confirmed the news late Thursday. Summit had first announced the partnership with the Texas-based cancer brand in 2016, and jointly built a new cancer facility in Florham Park as...

www.roi-nj.com

 

[deleted941485]

In this healthcare environment not sure how long such a setup can last:

Summit Medical Group ends relationship with MD Anderson | ROI-NJ

Summit Medical Group has ended its relationship with MD Anderson, ROI-NJ has learned. Summit CEO Dr. Jeffrey LeBenger confirmed the news late Thursday. Summit had first announced the partnership with the Texas-based cancer brand in 2016, and jointly built a new cancer facility in Florham Park as...

www.roi-nj.com

Great I hope more follow. It’s dollars down the drain that places that aren’t the hallowed MDA or MSKCC who basically get multiples of what community hospitals and PPs for the same treatment.