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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
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What is academic medicine’s historical legacy?
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The Legacy of Abraham Flexner for Medical Education
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Your Own Legacy
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The Culture of Education
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The Legacy of James B. Wyngaarden, M.D. for Biomedical Research
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The Culture of Biomedical Research
Source: NIAID, 2011
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The Legacy of Lyndon B. Johnson for Health Care
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The Culture of Health Care
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Our institutional financial reality
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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
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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
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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
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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
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The Cauldron
Tuition and Appropriations
Grants andContracts
Physician andHospital
Revenues
Education
Research
Clinical Care
Discretionary Fund
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Our national political reality
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A Bipartisan Moment…
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…Followed by a Partisan Statement…
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…Followed by Local Conflict…
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…Followed by “Super Failure”…
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…Followed by a Supreme Decision…
Corbis/AP Photo/Dana Verkouteren
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…Followed by ???
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Our national economic reality
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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
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Crossing a Dangerous Line
Source: http://usdebt.kleptocracy.us/
$15 Trillion is equal to:• U.S. GDP 2011 • U.S. Debt 2012
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© 2012 AAMC. May not be reproduced without permission.Source: Gapminder.com
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Our national health care reality
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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
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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”
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49.9 Million Americans are Uninsured
That’s 16% of the total population, or the equivalent of the combined populations of 24 states.
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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.
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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 .
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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
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© 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
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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%
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Boston, MA Health Status
Source: Commonwealth Fund Scorecard on Local Health System Performance, 2012
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Boston, MA Health Status
Source: County Health Rankings & Roadmaps, Robert Wood Johnson Foundation, 2012
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In the face of these realities, what future should academic medicine seek to create?
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Creating a “True” Health Care System
Care Model
Workforce
Economic Model
American Attitudes
Institutional Culture
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Rethinking Our Approach to the Medical Education Continuum
Premedical
Medical School
Residency and Fellowships
Practice
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Premedical Medical SchoolResidency and
Fellowships Practice
Creating a True Continuum of Medical Education
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Creating a True Continuum of Medical Education
Premedical Medical School Residency and Fellowships Practice
Learning
Assessment
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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
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Transforming Academic Medicine Will Require a Different Culture
Collaborative
Team-based
Service-based
Mutually Accountable
Patient-centered
Hierarchical
Autonomous
Competitive
Individualistic
Expert-centered
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Transforming academic medicine will require a new view of excellence
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The Rankings
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© 2012 AAMC. May not be reproduced without permission.Source: The New Yorker, February 2011
The New Yorker
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Consensus on Rankings
Chronicle of Higher Education October 27, 2011
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The Excellence Around Us
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“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
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How is Boston University demonstrating the new excellence?
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BU Cares
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Service Learning
VA Boston Healthcare System
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International Collaboration
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