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an online version of the magazine Fall 2009

Perilous Times Ahead?

Why academic medical centers should be key to health care reform.


By Dean/CEO Edward D. Miller, M.D.


Illustration by Sherrill Cooper

Academic medical centers—the crown jewels of American medicine—stand at a dangerous intersection. With appropriate support, the nation’s 125 AMCs and 400 teaching hospitals could spearhead the drive to bring quality health care to tens of millions of currently uninsured Americans, while ratcheting down costs via innovative care delivery models.

Leading the way in reshaping the health care system would be an appropriate adjunct to our historical mission of teaching, research, and treating patients. Yet it could be perilous.

What if health care reform also means sharp reductions in medical reimbursements? Academic health care centers would suffer immense harm. After all, Hopkins and other AMCs survive on very slim margins. Will leaders in Washington address the manpower needs that are implicit when you extend health insurance to millions more people? If they don’t, AMCs could be under water financially in a big hurry and in no position to meet the public’s expectations. Will research grants be sacrificed to reduce the federal deficit? Discoveries brought from the lab to the bedside at AMCs could be stifled. Clinical care would suffer if we did not have the funds to try anything new or different.

Academic health care centers are unique. Consider:

We are the first to embrace new technologies.
Only academic medical centers have the resources and infrastructure to take on highly complex technical challenges. Our full-time faculty members thrive on opportunities to advance medical science, measure the effectiveness of new approaches, and fine-tune medical devices for wider use.

Academic health care centers have turned patient safety into a science.
Hopkins’ Peter Pronovost gained wide acclaim for his painstaking research and measurement of new safety protocols, including a simple checklist that has dramatically cut ICU infection rates across the United States and Europe. Making medicine safer entails considerable changes in culture—changes that are taking place first at academic health care centers.

We offer superb learning environ- ments—for future doctors as well as staff and faculty.
Education is incorporated into every- thing we do. That is why classrooms and conference rooms are being built into Hopkins’ new clinical towers to further lifelong learning experiences. At AMCs like Hopkins, thanks to high-tech simulation centers, students and faculty master surgical and bedside skills and experiment with new techniques—without ever touching a patient.

Academic health care centers form an essential part of the nation’s safety net.

Most AMCs serve poor, urban communities. The majority of patients come to our emergency rooms with significant disease burdens. Though academic health care centers constitute only 3 percent of the nation’s hospitals, they deliver 41 percent of all indigent care. At Hopkins Medicine, we spend more than $175 million a year on uncompensated care and much more on community outreach.

Most medical breakthroughs occur at AMCs. They are also where you find the highest standards of clinical care. Hopkins annually leads the nation in NIH research grants. AMCs dominate the list. Our commitment to innovation, discovery, and collaboration makes us an ideal proving ground for new drugs, devices, technologies, and protocols that advance medical practice and improve the nation’s health.

Academic medical centers foster revolutions in the classroom.
At Hopkins, tomorrow’s physicians are gaining a groundbreaking understanding of genetic medicine and societal factors that impact individual health. They will be better prepared than any prior generation to meet the growing health care needs in this country. And they will spread the mastery of best practices learned at AMCs to community hospitals and other health care centers.

AMCs make huge contributions to the financial well-being of local communities.
The combined economic impact of AMCs and teaching hospitals exceeds half a trillion dollars. Johns Hopkins Medicine’s economic impact in Maryland exceeds $6.5 billion. We employ more than 30,000 people.

AMCs are ideally positioned to deliver innovations needed under health care reform.
The synergy that flows from combining teaching, research, and clinical practice makes AMCs the right place to develop, test, refine, and initiate improved care delivery methods to handle a tidal wave of new patients.

In recent months, I have joined my fellow AMC deans in visiting members of Congress to help them understand the incredible value of America’s academic health care centers. We’re not part of the problem, we tell them, but rather a core part of any solution. *

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