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ll last autumn, local newspapers crackled with articles about negotiations behind closed doors between Johns Hopkins and other health care organizations. Then, in quick succession, came announcements that we had worked out two separate arrangements—a partnership with an ultramodern medical center on the other side of the world in Singapore, and the purchase of Howard County General Hospital, just down the road in Maryland. Such is the world of health care today.

Hopkins’ founding fathers would no doubt have shaken their heads in disbelief at the thought that the institution that would shape the course of American medicine in the 20th century some day would find itself seeking out business relationships with other organizations. But they could not have imagined how different the end of this century would prove from the beginning. They couldn’t have guessed that tough managed care organizations would come to dominate medicine, making it almost impossible for an institution, no matter how grand, to go it alone.

Our founding fathers, however, could take solace in knowing that despite the hard edges that have crept into health care, it is still their vision of a medical center that truly integrates teaching, research and patient care that guides us. What complicates the picture today is the simple fact that training tomorrow’s physicians and maintaining a thriving research enterprise are now expensive propositions. Over the years, it’s become the clinical end of academic medical centers that funds a good part of these activities. But as managed care has curtailed the dollars we can collect in patient care fees, even a Johns Hopkins has had to delve into new business relationships to maintain its economic base.

C.E.O., Edward D. Miller, M.D. In my role as CEO for Johns Hopkins Medicine, much of this last year has been caught up with building those relationships. We’ve explored alliances with area practitioners, health care centers and free-standing services, all with the goal of assuring a flow of patients to Hopkins through what’s called an integrated delivery system. This sprawling network of services will give us the ability to provide patients with every level of treatment—from basic medical care to highly complex procedures—under one mighty umbrella.

As we’ve hammered out the details for each of these potential relationships, our own very skillful team of financial experts and lawyers has spent hundreds of hours around the bargaining table negotiating with representatives of these other organizations.Do not think, however, that Hopkins is permanently in the business of buying hospitals. It’s been a lengthy process that’s helped me gain a deeper appreciation for what we cherish about Hopkins. It’s also taught me why community physicians often view us cautiously—like an 800-pound gorilla.

In the end, some partnerships have moved forward better than we’d dreamed. Others—like our well-publicized near alliance with the Helix Health System—never came to fruition. But success or failure, the act of paring down each potential collaboration to minute levels of detail has crystalized for me just how far we are willing to go to build a stronger market presence for Hopkins.

I’ve come to understand that our name and our quality must be guarded. But I’ve also learned that Johns Hopkins cannot maintain the rigidity it may have demonstrated in the past if we’re going to partner successfully with a community hospital like a Howard County General.

Culminating the deal to buy that facility, I confess, was a high point for me and a purchase that made amazing good sense strategically. Located in the fastest-growing county in Maryland, the hospital is half way between Baltimore and the Washington, D.C., beltway, where we already have an alliance with Suburban Hospital in Bethesda, Md. Howard County General also is close by the Johns Hopkins Applied Physics Laboratory with its 2,000 employees. With this well-run hospital now part of our network, we gain the ability to treat some patients at a superb low-cost site rather than on our relatively expensive main campus. The relationship will benefit Howard County as well, as we add programs, technologies and eventually people that broaden its capabilities.

Do not think, however, that Hopkins is permanently in the business of buying hospitals. My feeling is that in a very short time we have been able to stabilize our clinical enterprise so that our teaching and research will not be threatened. Our hospital volumes are up. Our faculty physicians are much more responsive to the needs of their colleagues in the community than they were just a year ago. And area doctors in turn are finding that Johns Hopkins can actually be a comfortable partner that will work constructively with them rather than behaving like an overbearing giant.

As we move forward, I can imagine Hopkins engaging in one or two more carefully thought-out purchases or alliances with other health care facilities or physician groups. And then, with a strong network of patient care in place, it will be time to halt our search for partners and pay attention to our own knitting.

Within our campus today work a group of clinicians and medical researchers recognized the world over. They are the essence of Johns Hopkins. As the 21st century looms large, the simple goal of our business dealings will be to provide them with the support they need to continue their work. When you come right down to it, we haven’t really strayed from the vision laid out by our forefathers as this century got under way.


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