- The Washington Times - Friday, July 3, 2009


For more than a century, when government identified a problem in health care, it counted on academic medical centers to partner in the solution. As health care reform moves forward, it is time to do so again.

Academic medical centers are uniquely qualified to provide the evidence-based, rigorous study necessary to ensure health care reform that adopts what works and not what we think works. In fact, government supports this role in many ways, including encouraging clinical research and training physicians in the latest science. Similarly, government should turn to academic medical centers to help realize the full promise of health care reform: improving quality and access to care while reducing cost.

To fully appreciate what academic medical centers contribute to health care reform, it is necessary to understand what they are and how they have helped in the past. Unlike many other hospitals, academic medical centers carry an added responsibility for the clinical training of new doctors, nurses and medical personnel as well as carrying out basic and translational research. They partner with medical schools and often universities, and they are few in number. Of the more than 5,000 hospitals in the United States, only about 125 are academic medical centers.

From their beginning, academic medical centers have responded to challenges facing this nation. In 1910, when the role of academic medical centers was first defined, it was possible to become a doctor through classroom study alone, without ever seeing a patient. Academic medical centers were given the task of training physicians in an environment alongside cutting-edge research and the full spectrum of clinical practice. As a result, the quality of doctors soared.

Academic medical centers also contributed to a boon in research. This, in turn, has led to major advances in diagnosis and therapeutics, including clinical advances in pharmaceuticals, medical devices and surgical technology. Cardiac advances, minimally invasive surgeries, vaccines and new treatments were developed and proven in the halls of academic medical centers.

Congress should once again look to academic medical centers to help move health care reform forward. For example, quality and information technology are two of the many areas in which academic medicine should play a central role.

Improving quality is job one. If health care quality is improved, it can reduce costs by eliminating unnecessary repeat visits, avoidable medical errors and unnecessary testing. Today, quality standards exist, but there still needs to be a research and clinical environment to scientifically and rigorously confirm that what we think are good measures of quality are in fact good medicine.

For example, the Centers for Medicare and Medicaid Services in April dropped one quality measure after the results of a scientific study. Although it had been assumed for years that beta blockers would preserve cardiac function during a heart attack, recent studies in fact show they may worsen the effects of a heart attack for a small number of patients.

Clearly, more studies should be done and soon, and academic medical centers have the expertise to do it. Many recent legislative proposals would lower reimbursements for medical care provided by doctors and hospitals that do not perform well against quality measurements. If we are to base reimbursements on quality measurements, it is critical that they be the right metrics.

Another job for academic medicine is to ensure the effectiveness of health-information technology. This has been a goal for some time: Create an interoperable information system to share patient information. But it will be expensive for doctor’s offices and hospitals to install these systems, even with government aid. It will be very expensive if these systems do not work properly from the start.

With their research and medical role, academic medical centers are excellent settings to test and work out the bugs of information-technology systems. The government should use these centers to develop an effective model in a real-world setting. Once these systems work properly, other hospitals and doctor’s offices should install them with training provided with the involvement of academic medical centers.

By studying these and other issues, academic medical centers can help policymakers improve health care while holding down unnecessary expenses. The savings realized could be used to increase access to health care and reduce the numbers of people without health insurance.

These are realistic roles for academic medical centers. They have the expertise and infrastructure to test, study and report their findings both to the government and the medical community. Government will provide oversight through congressional steering committees and through the research supported by the National Institutes of Health.

The potential exists today to develop health care reform through rigorous application of science to improve the lives of patients and contain costs. It is a role academic medical centers have shared with government many times before.

Dr. Herbert Pardes is president and chief executive officer of New York-Presbyterian Hospital.

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