Maintaining a Margin

Filling "buckets" with new ventures will sustain and enrich our mission.

By: Edward D. Miller, MD
Date: February 18, 2011

Sherrill Cooper

Every winter over the past 15 years I’ve gathered together senior leadership to review the previous 12 months and look ahead. These annual sessions give top managers a chance to grasp the enormous scope and depth of Hopkins Medicine, which is now a $6-billion-a-year enterprise.

The theme at November’s Leadership Meeting was “Mission-Driven Growth,” which was apt given the spate of moves we’ve made that dramatically enlarge our global, national, and regional presence. Indeed, colleagues and friends have asked me: “Why?” They want to understand the rationale behind these developments far from the Dome.

Think of it this way: We’re filling buckets with new ventures that will sustain and enrich Hopkins Medicine and its historic mission.

Into the first bucket, I’d place our merger with Suburban Hospital in Bethesda and with Sibley Memorial Hospital in northwest Washington, D.C. These medical centers—roughly five miles apart—provide quality treatment for a large volume of patients in the National Capital Region.

If patients want to receive Hopkins-caliber care close to their homes near Washington, they no longer have to travel far. This extends our reach at a time when health care reforms, especially reimbursement cutbacks, force us to look at different delivery models.

Given this new environment, Hopkins must serve a larger population of patients within the Baltimore-Washington area. Suburban and Sibley, along with Johns Hopkins Community Physicians and its 26 outpatient sites, help achieve that objective.

Now the challenge is delivering superior care at lower cost for this regional population. Increasingly that means thinking in terms of preventive programs. It means identifying high-cost, high-risk groups of patients and employing inexpensive methods to keep them healthier.

Here’s an example from Paul Scheel, chief of the Division of Nephrology, who studied four years of data on emergency department visits by kidney patients enrolled in Priority Partners, our managed-care organization (MCO) for low-income Marylanders. By using a nurse coordinator to spot patients struggling with their dialysis treatments, the MCO cut emergency department visits in half. Total cost per patient dropped from $10,297 to $5,485. The nurse coordinator carefully monitors dialysis patients, arranges for doctors to clear up problem situations on an outpatient basis, and educates members on how to avoid difficulties.

Priority Partners identified a high-risk population, came up with ways to keep patients in good health and saved a bundle. Major employers are looking for programs like this. So are government officials. It’s a winner for everyone.

Into the second bucket, I’d place our hoped-to-be merger with All Children’s Hospital in St. Petersburg, a 259-bed facility with 10 outreach centers along Florida’s west coast. This busy hospital provides superb care but it wants to develop a first-rate academic reputation and expand its clinical and basic research. This gives us a rare chance to create a residency program from scratch—a model for training 21st-century pediatricians.

All Children’s opens up avenues for pioneering bench and clinical investigations, too, through new research centers with shared faculty and facilities. We intend to improve quality, safety, and cost-efficiency at the Florida pediatric hospital in ways that also enhance our core enterprises in East Baltimore. To me, it’s another win-win.

The third bucket we’re filling is in Malaysia where Hopkins is helping to start a medical school, based on our groundbreaking “Genes to Society” curriculum, along with a 600-bed teaching hospital (see p. 4).

Both the Malaysian government and the private sector are fully supportive. Hopkins will be at the forefront of turning out high-quality physicians for this fast-developing nation of 28 million. The goal is to make Perdana University Hospital and its Graduate School of Medicine—opening next fall under our vice chair of education, Charles Wiener—a mecca of medical excellence in Southeast Asia.

Once again, resources will flow back to East Baltimore to support our central core. By filling these buckets, we’ll make sure there’s enough of a margin to maintain Hopkins Medicine’s tripartite mission.

These recent developments give us quite a diverse portfolio. We’re balancing expanded clinical care with expanded research and teaching opportunities. New horizons are opening for our faculty. We’ve also fortified our future financial base.

These are exciting times for Hopkins Medicine. Yet every move was carefully thought out. We have been cautious and strategic. We remain steadfast in our commitment to mission-driven, quality growth that creates synergies and helps transform medicine in ways that benefit humankind.