Category Archives: The Practice of Medicine

UNC and Wake County Physician Partnerships

Last week, I had the opportunity to speak about the future of academic medicine to the Wake County Medical Society alongside Dr. William J. Fulkerson, executive vice president of Duke University Health System. I have included my remarks below.

A lot is happening in medicine and health care, in the nation, in North Carolina and in Wake County. I am pleased to join with my Duke colleague, Bill Fulkerson (Executive Vice President, Duke University Health System), on this program tonight, to discuss issues of common interest. All that we do has to be done in a way that meets the health needs of our fellow North Carolinians, and improves the care that they receive.

We at UNC Medicine and UNC Health Care are leaders in research, teaching and clinical care. We have much to celebrate. The recent 2011 USN&WR rankings of the nation’s medical schools put us #2 for primary care and #20 for research. More than half of all UNC research dollars were awarded to School of Medicine investigators.

And we are working to provide even more research opportunities. We, like Duke, are one of 55 institutions nationwide who have received an important, large NIH grant that enables us to speed the implementation of new ideas and technology into clinical practice, and to collaborate with new partners.

We are currently collaborating with more than 600 community members across the state in all areas of medicine, and we invite you to partner with us in these new research opportunities. They are specifically designed to move us out of our traditional university research environments, to be much more engaged with the community. You can find more information about this on our website: http://www.tracs.unc.edu.

At UNC we take our educational mission very seriously. We have long partnered with others across the state to train our medical students and our residents and fellows. A full 40 percent of the clinical experiences of UNC med students occur outside of Chapel Hill – WakeMed is an important educational site for us here in Raleigh. And our residency programs are much intertwined with WakeMed’s clinical activities here, too.

We have recently announced the formation of two branch clinical campuses of the UNC School of Medicine, in Charlotte and Asheville, which will allow us an even more focused way to educate medical students there, and to expand the size of our med school class.

UNC Health Care Now and in the Future
UNC Health Care, including Rex Healthcare, employs more than 12,800 people, and last year we saw more than 270,000 patients. We provided almost $300 million in uncompensated care – an important part of our mission to serve the state, a substantial portion of which was to residents of Wake County.

Rex Healthcare expands our reach to the people of Wake County. The NC Cancer Hospital at Rex, set to open in 2014, will be a dedicated cancer center here in Wake County. It will provide patients access to the resources of UNC’s NC Cancer Hospital, which opened last year.

New Opportunities for Partnership
We believe academic institutions, local health care providers and physician groups will work even more closely together in the future, as we together face pressure to serve patients better and more cost effectively.

It is about more than just payment rates. Success in the future will require physicians and hospitals to become true partners in the delivery of coordinated, quality, lower-cost care.

We think academic health centers like ours are a good starting point. For the most part we are already integrated within our organizations – and now we are reaching out to partner with others across our communities. We have no cookie cutter approach to physician relationships – we have created partnerships that include employment, joint ventures and academic affiliations.

Rex and UNC have a decade-long track record of successful collaboration with physicians. We are always happy to have you speak directly with those physicians to learn more about how they view UNC/Rex and how they view our approach as a partner. Our guiding philosophy has been to partner with the best physicians in a community, and to help ensure that we get patients to the right care at the right time. In particular, this means that if the needed care can be provided locally, it should be provided locally, by our partner physicians. Certainly we want to be available at UNC for your patients, as we are to all of the people of North Carolina, for tertiary or quaternary medical care. But we have no intention of siphoning patients from your market. Again, our partners at Rex and in the community can validate our success with this model.

Leading organizations will be the ones that understand how to work collaboratively and effectively with physicians. We recently launched Triangle Physician Network (TPN), a joint effort of UNC and Rex to operate a regional network of leading physician practices. There are currently more than 130 physicians in TPN. It is led by physicians, for physicians.

Our strategy for affiliation is simple – we listen to and work with quality doctors to develop mutually beneficial relationships. We want and need physician help with making this strategy work well over the long haul – to improve what we are doing today and to develop innovations for the future. Improving communication and care coordination is an important aspect of this effort – I am on the board of the new NC Health Information Exchange, and we are fully committed to providing our primary care and specialty physician practices the ability to coordinate with the latest in electronic medical records and other technology.

The Road Ahead
There are many challenges ahead. There is an urgent need for more primary care providers, especially in rural and other under-served areas. Health reform is a big unknown, especially with the political turmoil around us – though I remain a firm advocate for thoroughgoing health reform. I am very much aware, as a former school of public health dean, that we need to make major progress in improving the health of the population – issues like smoking cessation, physical activity and the obesity epidemic.

I appreciate the work that all of our colleagues do to meet the challenges before us. As I said earlier, all we do has to be done in a way that meets the health needs of our fellow North Carolinians, and improves the care that they receive.

New Leaders for UNC Medicine and UNC Health Care

A new academic year has just begun, with a new group of students.

And we have a new group of leaders for the UNC School of Medicine and UNC Health Care.

Not everyone is new, to be sure, but we’ve tapped some new leaders and moved others into new roles and new titles.

¢ Marschall Runge, MD, PhD, is Executive Dean, my principal deputy for the School of Medicine, and his focus is the academic affairs of the school. He is leading the effort to create a new strategic plan for the School. In addition, he will be the director of the NC TraCS Institute and PI for UNC’s CTSA grant. He remains chair of the Department of Medicine.

¢ Kevin FitzGerald, MPA, is Vice Dean for Finance and Administration, the principal leader of the School focusing on management and operations across all our missions. He continues to be our liaison to the NC General Assembly.

¢ Terry Magnuson, PhD, is Vice Dean for Research, the principal research leader for the School. He remains chair of the Department of Genetics. He oversees graduate education in the basic medical sciences, working closely with Warren Newton. He is leading the effort to create a new research plan for the School.

¢ Warren Newton, MD, MPH, is Vice Dean for Education, the principal education leader for the School. His primary focus is medical student education, but is also charged with integrating all our medical school activities, including allied health education, continuing medical education, graduate medical education and graduate education in the basic medical sciences. He remains chair of the Department of Family Medicine.

¢ Allen Daugird, MD, MBA, is President of UNC Physicians and Associates, the principal leader of the School’s faculty practice plan.

¢ Rick Pillsbury, MD, is Chair of the Executive Committee of UNC P&A, the new group of chairs who are Al Daugird’s principal advisory group. He remains chair of the Department of Otolaryngology / Head and Neck Surgery.

¢ Paul Godley, MD, PhD, is Executive Associate Dean for Faculty Affairs, the principal leader in the dean’s office focused on developing our faculty and working with them to assure their success.

¢ Amelia Drake, MD, is Executive Associate Dean for Academic Programs, directly assisting Marschall Runge, Kevin FitzGerald and me with key tasks in leading the School’s academic initiatives.

¢ Tony Lindsey, MD, is Executive Associate Dean for Clinical Affairs and Chief of Staff of UNC Hospitals, working with Marschall Runge, Gary Park and others to advance our clinical and quality activities.

¢ Chris Ellington, MBA, is Executive Vice President and Chief Financial Officer of UNC Hospitals, the principal financial leader of the Hospitals.

¢ Brian Goldstein, MD, MBA, is Executive Vice President and Chief Operating Officer of UNC Hospitals, the principal operations leader of the Hospitals.

We have a very good team in place — with these leaders and the others who continue in their important roles.

And we are off to a good and fast start to the new academic year.

Challenges, successes shared with UNC faculty

Fall has most assuredly arrived in Chapel Hill. The leaves are especially colorful this year, the morning air has been crisp more than once, and, as dean of the UNC School of Medicine I had the honor of delivering my fall address to the faculty.

This year provided ample reason for reflection. We have faced many challenges, many of them stemming from the financial crisis that was felt by individuals and institutions around the world. But I was also able to cite a long list of accomplishments for which the faculty deserve much of the credit. Among those I mentioned:

¢ We graduated and matched a wonderful class of medical students, and we filled all of our own residency positions with outstanding doctors

¢ We again ranked second overall for primary care on the U.S. News & World Report Best Medical Schools list; and we were twentieth overall and sixth among public schools of medicine for research

¢ UNC Hospitals was included among the U.S. News & World Report Best Hospitals, and ranked among the top 5 percent in H-CAPS scores

¢ We received the third highest score among all hospitals for patient satisfaction with nursing

¢ We opened two world-class facilities: the Genetic Medicine Building, the most sophisticated science building ever constructed at UNC, and the long-awaited North Carolina Cancer Hospital, which welcomed its first patients in August

¢ UNC faculty received more than $350 million in research grants in 2009; our funding from the NIH has increased 15 percent since 2007

¢ As of October, the medical faculty have received 150 awards totaling almost $50 million from the American Reinvestment and Recovery Act (the Stimulus bill)

However, the loss of jobs across the state has had a significant impact on UNC Health Care because of the growth in uninsured North Carolinians. Unemployment across the country weighs heavily as citizens and members of Congress consider health reform. The economy and health care reform were on the minds of many of the faculty at this meeting.

As I have stated in this blog many times before, health reform is an economic issue as well as a health issue. We feel that very acutely at UNC. I repeated to the faculty my belief that every American ought to be insured, and we, as a nation, need to change the way we provide health care to focus on keeping people well.

Fortunately, UNC faculty are also leading the way in creating and expanding new ways to organize and deliver quality health care services in a more efficient manner. We want UNC to be a national leader in this area.

The faculty asked questions about the challenges of our growth, including the scarcity of space. In some respects this is a good problem to have, but it is surely hard to solve, especially quickly. We also talked about our proposed new hospital in Hillsborough.

Because of the economy we have tightened our belt, but the Imaging Research Building is under construction, and we hope to open the Hillsborough hospital, if we get CON approval, in 2014.

Many of our challenges are not unique to UNC. They're faced by practically every academic medical center in the country. However, the level of excellence and the spirit of collaboration and collegiality among UNC faculty sets us apart. It is through their efforts that we answer challenges creatively, and will continue to find innovative ways to conduct research, provide patient care and educate.

Caring for patients in the N.C. Jaycee Burn Center

Our hearts go out to the patients and families of the horrific incident at the ConAgra plant in Garner.

Several hospitals in our area received patients from this tragedy, including our own Rex Healthcare. But those with the most critical injuries came to UNC, where the N.C. Jaycee Burn Center is the largest in the region. Some of these patients will surely require months spent in our burn center, and possibly years of follow-up care.

The families of our patients, like those from other tragedies and traumas, will have a difficult fight, also. Even in the best of times these injuries would be life-altering; in the financial straits in which the country and our state finds itself, they are sure to be doubly so.

UNC has experienced these tragedies numerous times the Kinston explosion in 2003, the crash at Pope Air Force Base in 1994 and the Hamlet chicken processing plant fire in 1991. It is in crises like this one that people are made aware of the burn center, but it is important to know that, according to national data, the average survivor with burns on 50 percent of his body stays in a burn unit almost 58 days, with a mean cost of around $447,000.

The center has 21 ICU beds, making it one of the largest in the country, and there is never a lack of patients to fill each bed.

Dr. Bruce Cairns, director of the burn center and associate professor in the Department of Surgery, very aptly says there is no such thing as a minor burn. Even relatively small burns require special acute care, and lengthy follow up.

Dr. Cairns, the resident physicians, nurses, social workers, therapists and myriad other staff members of our burn center continually perform with at the highest level of professionalism, and I thank them for it. They take very seriously the NC Jaycee Burn Center's mission to support the entire state, and the region, and they show that time and again not only with the excellent inpatient and clinical care they provide, but also with educational outreach programs throughout the state, and they make all of us at UNC proud to work here.

We wish our patients and their families well, and we pledge, as we do for everyone we care for, our commitment to providing them the best care possible.

You can receive updates by following the UNC Health Care News Twitter feed, and this video is an update of the patients and an explanation of burn care by Dr. Cairns and nurse manager Grace Schmits.

CDC manages swine flu

As a new strain of swine flu appears in the United States, the U.S. Centers for Disease Control and Prevention once again takes the lead.

The CDC, based in Atlanta, is uniquely qualified to deal with potential public health crises whether infectious diseases or other challenges. Its epidemiologists and laboratory scientists work in close partnership with colleagues around the world, as they are now, in Mexico, where this H1N1 flu strain first emerged.

Fortunately, we have not had any reported cases of swine flu in North Carolina. But at UNC we are taking the matter very seriously. We are taking extensive precautionary measures to ensure we are prepared to care for patients who might arrive at our doors, and to protect our staff who care for our patients.

The White House and the CDC reported today in a news briefing that each of the 20 people in the United States who contracted the flu has recovered without medical treatment. Basic hygiene practices, such as hand washing, covering your mouth when you sneeze and staying home when you are not feeling well go a long way to controlling the spread of even the most worrisome flu.

I applaud my former colleagues at the CDC, which I directed in the early 1990s, and I wish them the best of luck. They are consummate professionals who work tirelessly to keep the American public safe from threats to their health.

A community discussion on health reform

I have just returned from a large town hall meeting today in Greensboro, on the campus of NC A&T State University.

It was hosted by Governor Bev Perdue and my friend, Nancy-Ann DeParle, the head of the White House Office for Health Reform, and counselor to President Barack Obama. This regional health reform forum was attended by several hundred people, and was well covered by the news media.

I think it served a very useful purpose to tell in compelling fashion what the problems are with our too flawed health care system in America.

A number of real citizens told their stories of the challenges they have had to find and keep health insurance, and their difficulties in navigating our much too complex system.

Nancy-Ann called on me, and I was able to tell the other side of this story what it looks like to try to run a large safety net institution when unemployment is surging and uninsurance is causing a tidal wave of indigent patients to come our way. I cited the figures from a recent NC-IOM study that showed that with each one percent rise in NC's unemployment rate, we lose $14.4 million dollars. Since the rate has gone from the 4+ range to the 10+ range the impact on us is nearly $100 million!

I also said that it is my belief that we have plenty of money in America's health care system we just are not spending it very wisely. And I went on to say that we each will have to be willing to make changes and make sacrifices for the common good.

Finally, I said that I am more hopeful than I have been in many years that we are about to do major health reform and I urged us all to work together to make that happen.

Afterward several of us were able to have a small group meeting with Nancy-Ann DeParle and to talk in more detail with her. I urged her to be bold and to press ahead with this most important effort. I told her that unless each of us are a bit uncomfortable they are not pushing us hard enough.

All in all a very encouraging day. Read more about the event from WRAL-TV, Raleigh here and WUNC radio, Chapel Hill here.

View more of my comments here.