Published in the December 2011 AAMC Reporter
By Whitney L.J Howell
As a surgeon, Robert Feezor, M.D., never expected he would eat earthworms at work. But as a father, he was thrilled to have the chance.
“It was Father’s Day, and they gave the dads earthworm ice cream,” said Feezor, assistant professor of vascular surgery at the University of Florida College of Medicine. “Basically, it was gummy worms in brownies, so it looked like earthworms in dirt. My son loved giving it to me.”
The treat came courtesy of Baby Gator, the medical center’s on-site day care facility where Feezor sends his three children—ages 5, 3, and 2—daily for a “stimulating educational child care experience.”
Accessible child care is one of the things that can add to the workplace attractiveness of an academic medical center. Baby Gator opened its on-site facility two years ago, joining other academic medical centers that have offered the same benefit—some for as long as 50 years. Many, including Yale and Stanford universities, have housed child care near hospitals and clinics for decades.
According to Sarah Bunton, Ph.D., AAMC research director of organization and management studies, longer hours of operation, close proximity to the hospital or clinic, and the possibility to see a child during the day make on-site day care a priority for faculty—both male and female.
“A dramatic change in the desire for on-site day care has been the increased number of fathers who want to be more involved with arranging care for their kids,” she said. “Through anecdotal reports from faculty affairs administrators and focus groups with select groups of faculty, more male faculty are also asking about and lobbying for this benefit.”
Baby Gator Director Pamela Pallas, Ph.D., said it was the medical school’s dean who first requested a location closer to the hospital.
“The dean called to tell me that top-notch residents were turning him down because he couldn’t guarantee he could offer appropriate child care,” Pallas said. “He was shocked child care was a deal breaker, but he wanted to know how we could get a Baby Gator close to the health sciences center.”
Within six months of opening, Pallas said, the center was at full capacity with112 children. There is now a waiting list 200 children long.
On-site child care is so popular, and the need for quality services so great, that parents scramble to put their children on waiting lists before birth. Some even make the attempt before conception. Jane Grady, Ph.D., associate vice president for human resources at Rush University Medical Center, once had a faculty member contact her upon getting engaged to ask if it was too early to put a yet-to-be-conceived child on the waiting list.
While the question amused Grady, who served as the first director of Rush’s Laurance Armour Day School, she was not surprised. Day care facilities at academic medical centers are more likely than other child care centers to have an educationally focused curriculum, making them a good choice for parents who already value extensive academic training, she said. Facilities on medical center campuses are also more likely to have highly educated staff.
“All our teachers have master’s degrees in early childhood education,” she said. “They are here to help the kids learn and have fun. We want to make sure they are well prepared for school at the same time we provide the excellent care the parents are looking for.”
During the 2008 presidential election, Feezor’s children learned about the various candidates and flags from different countries. When they learned about gardening, his 3-year-old enjoyed showing off the watermelon every time Feezor picked him up on the playground.
From the faculty perspective, paying for medical center-connected on-site day care can be easier than paying a center in the community, Grady said. Faculty can often choose from payroll deduction, using their health savings accounts, or monthly check.
Although these centers are coveted and provide an appreciated benefit to faculty, starting a day care facility is not always simple, said Phillips Kerr, director of compensations and benefits for the University of Massachusetts Medical Center-Worchester, which opened its facility in August 2010. The biggest stumbling block is finding an adequately sized space, as well as the funds to complete renovations, hire staff, and purchase necessary resources. In fact, he said, the best option could be outsourcing the day care’s administration.
“Fortunately, the university owned the space we used for the school,” Kerr said. “But rather than build everything from the ground up, the university decided to partner with an existing company to run the school. It’s been a positive experience.”
To read the article at its original location: https://www.aamc.org/newsroom/reporter/december2011/268878/childcare.html
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December 12, 2011
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Education, Family, Healthcare | Baby Gator, challenges of on-site medical center daycare, child care benefits at medical centers, child care facilities at Stanford University School of Medicine, child care facilities at Yale University School of Medicine, earthworm ice cream, Jane Grady, Laurance Armour Day School, medical center on-site daycare curriculum, on-site daycare privileges increase academic medicine faculty productivity, Pamela Pallas, Phillips Kerr, popularity of on-site medical center daycare, Robert Feezor MD, Rush University Medical Center, Sarah Bunton, University of Florida College of Medicine, University of Florida's on-site child care facility, University of Massachusetts Medical Center-Worchester |
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Published in the December 2011 AAMC Reporter
By Whitney L.J. Howell
The release of the Centers for Medicaid and Medicare Services (CMS) final rule on accountable care organizations (ACOs) in October is helping some AAMC members take a second look at ACOs. Experts are debating whether the final rule, which excludes indirect medical education payments from the shared-savings mix, will help academic medical centers embrace the ACO model.
In an ACO, a network of doctors and hospitals will share responsibility for providing patient care to a minimum of 5,000 Medicare beneficiaries for at least three years. CMS begins accepting applications for the Medicare Shared Savings program in January.
If the U.S. Supreme Court rules that the health reform law is unconstitutional, ACOs and shared savings could become irrelevant. However, many in academic medicine are proactively aligning resources to provide services in quality-focused, collaborative ways to control costs. For some, that means launching multi-disciplinary, patient-centered care centers. For others, changes include integrating health information technology or adding “total health” courses into curricula.
There is no cookie-cutter approach to adopting the ACO model. Academic medical centers must identify strategies that work best for them, but it will be challenging, said Scott Berkowitz, M.D., M.B.A., Johns Hopkins Medicine’s accountable care medical director.
“There will be cultural and financial obstacles,” he said. “But academic medical centers have a golden opportunity to create value in the post-reform era through providing exceptional patient-centered care, engaging in the science of care delivery to supplement more traditional research, and by educating the next generation of health care leaders.”
Johns Hopkins is still reviewing the Shared Savings program but has improved care quality in recent years through several initiatives. The institution expanded its community physician group to more than 250 doctors, including many to augment patient access to both preventive and follow-up care, Berkowitz said.
There are, however, academic leaders who doubt their centers can achieve the ACO model, said John Kastor, M.D., a professor at the University of Maryland School of Medicine. In a February New England Journal of Medicine perspective, Kastor reported that of 37 senior faculty he surveyed nationwide, most believe the ACO structure will prevent care coordination and cost savings.
“Of the people I interviewed, none has figured out how to make this concept work at their center,” Kastor said. “Medical school deans and hospital CEOs often report to different people. Clinical departments tend to be in silos, and training students takes time. These issues will hamper an institution’s ability to form a successful ACO.”
Changing characteristics of teaching hospitals, including paring down didactic resources, to cut costs requires a significant culture shift, he said. But not all would be beneficial. According to AAMC, siphoning money from educational efforts to achieve savings—such as indirect medical education payments—undermines academic medicine’s tripartite mission.
“In our philosophy, these payments are for education and care of the uninsured,” said AAMC Chief Health Care Officer Joanne M. Conroy, M.D. “Excluding them from savings calculations prevents negative impacts on patients, and it stops any gutting of our care system or educational programs.”
However, the onus now weighs heavily on teaching hospitals and health systems to identify cost-saving strategies and demonstrate that they work.
“It’s still a tough road,” Conroy said. “It’s a complex rubric. Academic medical centers must drill down quickly to see what will be successful.”
For Greenville Hospital System University Medical Center in South Carolina, success is already here. According to chief medical officer Angelo Sinopoli, M.D., Greenville began working toward collaborative care nearly seven years ago and first tested the ACO model on its 17,000 employees. Using a $2.7 million Duke Endowment grant, the institution increased preventive care for employees and provided case managers for the sickest patients. The result was a 26 percent drop in emergency department visits and a 55 percent decrease in hospital stays.
The true key to success, Sinopoli said, was when hospital administrators offered on-site health care services to area businesses.
“It was part of our system change. We took our wellness programs to them,” he said. “Depending on the organization’s size, there is a nurse practitioner or physician there to provide a continuum of care, give high-risk patients health education, and eliminate social barriers to care.”
Having a Greenville-affiliated provider in the workplace gives patients more than the typical 20-minute doctor’s visit. They also have access to social workers, case managers, and practitioners who address their needs between appointments.
Achieving this goal was difficult. According to Sinopoli, Greenville faced two challenges when creating its collaborative-care environment. It took 10 years for physicians to embrace the model. The concept is foreign, he said, because physicians train as individuals and are not accustomed to working in teams.
The medical center also purchased health information technology to track accurate patient data, integrate it between sites, and make it readily available to providers. Along with an electronic health record system, the medical center installed a data warehouse so practitioners can mine existing data.
The institution is a newcomer to academic medicine, having joined South Carolina’s University HealthSystem Consortium in 2006, but it pivoted easily to train students about team-based care.
“Our curriculum and students are oriented to total health,” Sinopoli said. “Instead of teaching just the biochemistry of heart failure and what drugs treat it, our curriculum teaches how to coordinate care for a congestive heart failure patient and what resources and evidence-based practices can keep that patient from being readmitted.”
Greenville is still considering whether to apply for the Medicare Shared Savings program, he said. Regardless of the institution’s eventual route, Sinopoli said one thing is certain: Leaders in academic medicine must continuously promote culture change to create a true shift toward patient-centered care.
To read the article at its original location: https://www.aamc.org/newsroom/reporter/december2011/268852/aco.html
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December 12, 2011
Posted by wjpalmer |
Education, Healthcare | academic medical centers identifying cost-cutting strategies, academic medicine challenges with accountable care, accountable care opportunity for academic medicine to improve patient centered care, accountable care organizations, ACOs, Angelo Sinopoli, Association of American Medical Colleges Chief Health Officer, Centers for Medicare & Medicaid Services Medicare Shard Savings Plan, coordinated care courses, drop in hospital stays due to accountable care models, drops in emergency department visits due to accountable care models, Duke Endowment Grant to launch accountable care model, getting physician buy-in for accountable care, Greenville Hospital System University Medical Center, hospitals administration buy-in for accountable care, Joanne M. Conroy, John Kastor, Johns Hopkins Medicine accountable care director, medical students learning about coordinated care, resistance to accountable care in academic medicine, Scott Berkowitz, South Carolina University HealthSystem Consortium, total health medical courses, University of Maryland School of Medicine |
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