Performance-Based 战略投资: The Evolution of a More Integrated School of Medicine/Teaching Hospital Funds Flow
The relationship between a school of medicine (SOM) and its primary teaching hospital has been and will continue to be a foundational element of an academic medical center (AMC). 通过他们在教育和研究方面的合作, the SOM and teaching hospital are able to differentiate themselves in the patient care marketplace and elevate their standing and status to levels that could not be achieved independently. 然而, the pressures on and uncertainty surrounding all major sources of funding for these two entities have never been greater, 这导致两国关系的财务基础受到越来越多的审视. SOM leadership and faculty members question the level of support that the teaching hospital provides in exchange for the services rendered and the value of the academic brand, while hospital executives struggle to define the value and return on investment (ROI) relative to the millions of dollars that the hospital typically flows to its academic partner. 正如我们在AMC集成的介绍性出版物中所描述的那样,1 the current environment demands more contemporary affiliation arrangements that describe mutual responsibilities and the value derived from the partnership.
The financial arrangements between an SOM and teaching hospital include a myriad of transactions, 但它们本质上可以定义为(1)购买的bet8娱乐或(2)战略投资.
… the opportunity for greater integration and alignment lies with an investment strategy that is grounded in business planning principles [and] is in line with performance.
购买bet8娱乐. 这些bet8娱乐包括大多数医院, 无论是学术还是社区, 必须安全, 例如临床项目/单位的医疗指导和关键临床bet8娱乐的覆盖范围(例如.g.麻醉). 事实上, teaching hospitals and SOMs (often in conjunction with a faculty practice plan) have made significant strides in improving accountability and transparency for purchased services through joint evaluation and decision making. 医疗主管的工作和绩效期望更加明确, 而扮演这些角色的个人会根据特定的标准得到奖励或被替换. 类似的, 临床覆盖要求和随之而来的支付更多是由处方驱动的, 灵活的, 并以公平市场价值原则为基础.
然而, this evolution in purchased service methodologies has not fully occurred in graduate medical education (GME), 这是一个对资产管理公司影响很大的领域. GME项目的存在定义了“教学”医院, 通过相关学术品牌实现显著的价值, 住院医师和研究员提供的临床覆盖, 以及内置的bet8网站备用招聘渠道. GME的财务安排, 虽然, are often based on a pass-through of direct GME reimbursement that is received by the hospital from government payers and/or a “block grant” budget rooted in history, 这两者都不能代表SOM承担的真实成本.
遵循其他购买bet8娱乐协议的领导, payments for GME program direction and teaching should be linked to an FTE requirement (often specifically defined by ACGME) and expectations of program performance (e.g.,匹配率,董事会认证合格率). Support for other costs associated with administering GME programs should also be benchmark-driven and formulaic (e.g., identified support per resident) to provide consistency and predictability while incentivizing cost management.
战略投资. Strategic investment by the teaching hospital in its SOM partner’s academic endeavors is rife with ambiguity and uncertainty, 尽管这对两党都很重要. This financial landscape commonly includes a hodgepodge of historical deals that predate current leadership teams, 未经证实的赤字支持, 资金承诺只能部分兑现(或者根本不兑现). 此外, in only very limited instances are the benefits to and performance of the SOM and teaching hospital linked to these arrangements. 通常需要一种零基础的战略投资方法, 将标准化的商业计划流程应用于每个投资机会. For mission-critical programs that require start-up and/or ongoing support, a fully loaded budget (i.e., 教师bet8网站备用, 中层提供者, 支持人员, 非人员和间接成本)必须明确界定, 医院和SOM的财政捐助也应该抵消这些费用. 财务业绩预测, 教师跨任务的努力, and productivity must also be included so that all parties understand commitments and expectations. 最后, risk profiling and an attendant remediation plan are necessary in the event that anticipated funding sources do not materialize or productivity levels do not achieve projected levels. This prevents a “fiscal cliff” from suddenly derailing a key programmatic investment and placing the SOM and teaching hospital in the position of determining which entity will provide additional support.
Another element of strategic investment that must continue to evolve is the discretionary or mission support provided by the teaching hospital to the SOM for academics. This is funding that the SOM dean has sole responsibility for allocating to mission-critical programs (including basic sciences) that put the “academic” in AMC. 在许多资产管理公司中, 这种类型的支持从未存在过, 在那些地方, 这种支付通常采取线上整笔赠款的形式. More progressive AMCs are aligning discretionary academic support with the teaching hospital’s performance.
此外, 与上面描述的针对具体方案的投资一样, the dean must clearly communicate to the teaching hospital and the SOM faculty how he/she has invested this funding through a business planning and monitoring process. 这种安排的结果是真正的双赢, 两个实体对可自由支配的资金水平有更大的可预测性, SOM faculty clearly seeing how their contributions within the teaching hospital link to academics, 教学医院展示了对AMC学术品牌的承诺.
While many AMCs have improved the clarity and objectivity of the purchased services agreements that exist between the teaching hospital and SOM, the opportunity for greater integration and alignment lies with an investment strategy that is grounded in business planning principles, 是否符合业绩, 它的核心是自由裁量的学术支持. This is a fundamental mechanism for instilling a sense of common purpose around clinical and academic programs and for strengthening the academic brand that will differentiate an AMC from community-based competitors looking to erode its market share.
脚注
- 1.
心电管理顾问, “AMC整合——实现真正结盟的五个机会点”,2012年6月.
2012年11月14日出版