365th MEETING OF THE MEDICAL SCHOOL COUNCIL
3 p.m., Wednesday, November 14, 2007
School of Medicine Administration, Board Room 103
PRESENT: Drs. Argani, Armstrong, Bergles, Bluemke, Cooke, Cromwell, Gerard Lutty (for Dagnelie), Efron, Geller, Goldstein, Halushka, Honeycutt, Jia, Li, Maragakis, Mears, Pomerantz, Schramm, Siberry, Stivers, Zellars, Mr. Pirruccello, Mss. Fairman, Foy, and Oliver.
ABSENT: Drs. Allaf, Bhatti, Brayton, Chan, Choi, Cormack, DeLeon, Flynn, Gould, Huang, Kravet, Leahy, MacDonald, Magaziner, McCarthy, Mooney (excused), Peters, Pidcock, Robinson, Sterni, Tompkins, Tufaro, Whitmore, Woolf, Yaster, Yehia, Mss. Nguyen and Warner.
GUESTS: Drs. Cook and Miller, Mr. Thompson, Mss. Brown, Conway, Hayes and Heiser.
The minutes of the October 17, 2007 meeting were approved. The revised minutes from the September 19, 2007 meeting were also approved.II. Presentation of the Report from the Baltimore Community Clinic Task Force - Mr. Steve Thompson and Dr. Barbara Cook
A task force with wide representation from Johns Hopkins Medicine, Nursing, Public Health, and Johns Hopkins Community Physicians was charged with determining the viability of a Johns Hopkins Medicine sponsored free primary care clinic in East Baltimore. Medical students were active participants in the task force. The task force developed an inventory of existing primary care delivery sites that provide services to the uninsured or underinsured residents of East Baltimore and developed a “gap” analysis and examined barriers to receiving care. The external assessment identified eight sites; the internal assessment identified five Johns Hopkins sites that are now available to the community.
The key findings showed clinics providing primary care services to the underinsured and uninsured residents of East Baltimore are well established. The clinics offer a wide range of primary care services with most clinics charging fees based on a sliding scale. Communication regarding the offered services is not optimal and many East Baltimore residents learn of the services by word of mouth. The patients experience extraordinary barriers to accessing primary care that must be overcome. Routine access to specialty care with Johns Hopkins is not currently available to this population.
The task force made several recommendations including establishing a standing committee on East Baltimore community health. Other recommendations included improving availability to specialty care, expanding volunteer opportunities for nursing and medical students, facilitating access to primary care and overcoming barriers, communicating policies and rational to students and faculty regarding clinical work outside courses and clerkships, and supporting meaningful health care reform. In conclusion, it was noted Johns Hopkins Medicine and the University have an important role in the health of the East Baltimore community and can be most effective by implementing the recommendations of the task force. East Baltimore residents, regardless of insurance status, should have access to a medical home and affordable primary and specialist care.
There was discussion of impediments to providing specialty care under current reimbursement arrangements. Dean Miller commented on the responsibilities of the federal and state government in caring for this patient population.
III. Annual Dean's Report to the Medical School Council - Dr. Edward Miller
A series of questions/topics were submitted to Dean Miller prior to the meeting. The following were addressed:
Role of the Medical School Council
Dr. Miller commented on the importance of communication and how the Medical School Council can be helpful in getting messages back to their constituents.
Johns Hopkins International
There was a concern that promises made by Johns Hopkins International are not being fully vetted by the School of Medicine. Dr. Miller reported the administration is considering a major international proposal and faculty would be informed as the proposal develops.
One hundred forty seven children are enrolled in the day care program. There is a waiting list for infants. The program breaks even except for a rent subsidy. Limited tuition scholarships are available to assist eligible postdoctoral fellows and housestaff. The Work-life Office has lists of the other options in the Baltimore area for those unable to access the program.
The current fringe benefit rate is 34% with a projected rate of 50% unless steps are taken to control costs. It is not expected the federal government will continue to fund rising fringe benefit rates. A faculty committee made the recommendation to, over a three year period, phase in a flat benefit dollar rate for faculty and staff. This action resulted in a decrease in benefit dollars for many faculty and senior staff.
IV. Changes in the Benefits Plan - Ms. Charlene Hayes, Vice President of Human Resources
Ms. Hayes reported on the three year plan to get to a flat rate for benefit dollars which was met this year. She also discussed the objective of having employees more accountable for health care costs and the incentive to have faculty and staff complete a Health Risk Assessment (HRA). Ms. Hayes acknowledged the methods used in communicating the changes were not optimal.
The Medical School Council supported the goal of promoting a healthy lifestyle and employee sponsored programs to achieve that goal. The council took issue with linking 100 benefit dollars to completion of the HRA and the lack of clarity with respect to the confidentiality of personal health information in the HRA. Cutting benefit dollars was viewed as a reduction in salary as it will cost more out-of-pocket dollars this coming year to maintain the similar benefits.
Ms. Patty Brown, President of Johns Hopkins Health Care, outlined different approaches to containing costs. She reported the Employee Health Program (EHP) is self-funded and our risk rests with us. The current trend in health care costs cannot continue and EHP has spent years looking for the best tools to manage risk. The HRA assessment tool is viewed as a well researched approach that has been accepted by industry. HRA information combined with claims information will help determine lifestyle intervention programs. Questions were raised regarding legal issues in using protected health information that may be used in hiring and firing decisions.
After presentations, the invited guests were thanked for their participation and excused.
There followed extensive discussion on the reduction in benefit dollars, the linkage of 100 benefit dollars to completion of the HRA, privacy and confidentiality issues of HRA data, communication about benefits and lack of transparency in the process. The question was asked if the Bioethics Committee had or should have had input into the approach taken in implementing the HRA.
Based on the above discussion the Medical School Council leadership was asked to prepare a written response to the Benefits Office.
Subsequent to the meeting the attached document, “Medical School Council Response” was drafted for Medical School Council approval at the December meeting.
V. Other Business
There being no further business this meeting was adjourned at 5:30 p.m.
Mary E. Foy
Future Medical School Council meetings:
All meetings will be held in the School of Medicine Board Room (SOM 103), 3:00 to 5:00 p.m.
December 12, 2007
January 23, 2008
February 20, 2008
March 19, 2008
April 16, 2008
May 14, 2008
June 18, 2008