February 19, 1999

‘Checkup’ reveals institution’s health

'Checkup' reveals institution's health

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Dr. Harry Jacobson at this week's state of the institution address. (Photo by Donna Jones Bailey)

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Among the staff and faculty at this week's state of the institution address were (from left) Dr. Tom Daniel, Dr. Barney Graham, Dr. John Oates, and Dr. Denis O'Day. (Photo by Donna Jones Bailey)

Vanderbilt University Medical Center had its annual checkup this week, and the diagnosis from institution leadership is, for the most part, favorable.

Before a large crowd of staff and faculty members on Tuesday, Dr. Harry R. Jacobson, vice chancellor for Health Affairs, outlined the state of the medical center, reviewing the past year and looking ahead to the future.

The past year was an active one; the future promises to be even more challenging, Jacobson said. One goal that remains unchanged is VUMC's commitment to continuous improvement in all three of its missions ‹ education, patient care and research.

Progress has been made in implementing the Strategic Plan for the Clinical Enterprise and the Strategic Plan for the Academic Enterprise, Jacobson reported, Core facilities have been bolstered and expanded and the office of the Dean of the School of Medicine has been restructured to enhance the educational mission.

While vital, the importance of these initiatives pales in comparison with the medical center's most important asset ‹ it's people.

"There are three things that will make this enterprise successful," Jacobson said. "One is resources. Another is a plan, intelligently created and doggedly pursued. But the third thing is maybe the most important ‹ it is the human resources needed to do it and a firm commitment to support you, direct you and clear the way for you to succeed and accomplish."

During this coming year, several initiatives will be implemented to help accomplish that. First is a comprehensive job satisfaction survey of all staff and faculty. The second will be the implementation later this year of a program called the Customer, a training initiative that begins with the premise that we have to treat each other well before we can provide our patients with an exceptional level of service.

Third, VUMC will adopt a "code of conduct" that will soon begin circulating that asks everyone at VUMC to protect patient confidentiality, manage the access to controlled substances, care for any patient in emergency need, and avoid conflict of interest.

Several important new programs and initiatives were begun and numerous key financial performance indicators rose during the past year, but there is still much to be done to achieve the stated goal of VUMC becoming one of the nation's top 10 academic medical centers. In his address, Jacobson highlighted some of the things that will do the most to determine the medical center's success in the future.

Institutionally, the past year has been a busy one, to say the least. Among the many highlights:

o Design and planning of the new Vanderbilt Children's Hospital ‹ set for lot 42 between the Capers Garage and the Dayani Center ‹ was begun and the fund-raising campaign is about to be launched.

o A partnership was announcedbetween VUMC and Meharry Medical College and Metro General Hospital. This new relationship again gives VUMC the opportunity to maintain strong teaching and clinical ties with Nashville's General Hospital.

o The Ingram family endowed the university with a gift of $350 million, which will have a profound impact on the medical center.

o A joint venture was established with the Nashville Healthcare Group, an 18-member primary care practice with five locations around the city.

o A partnership with the Page Campbell Cardiology group was announced, which will dramatically improve VUMC's market position in heart services. This partnership has led to the creation of the Page Campbell Heart Institute in the Caper's building.

o A partnership agreement was signed with Concentra Medical Services, one of the nation's leading providers of work-based injury and illness services.

o VUMC took over sole ownership of the Psychiatric Hospital at Vanderbilt.

Jacobson reported that for only the second time in its history, admissions to VUH topped 30,000 last year, a 5 percent increase from the previous year. The Vanderbilt Clinic saw more than 500,000 patients, an impressive increase of 14 percent from the previous year.

Efforts to reduce average length of stay continued to show improvement, dropping from 5.4 days last year to 5.1 so far this year. This improvement is even more impressive considering that Vanderbilt patients are, on average, sicker than patients at other area hospitals.

Even with more severe cases, cost per discharge ‹ a measure of efficiency in providing care ‹ rose only 1 percent during the year. Charges per patient were right at, or below, the market.

"For an academic medical center that accepts just about every patient in every condition, a place where patients with unusual problems are commonplace, these results are impressive and very encouraging," Jacobson said.

The medical center's financial performance the past year was "solid, but not brilliant." VUMC as a whole had a positive bottom line of $15 million, down from $23 million a year ago. As has been the case for the past four years, much of the deterioration in income is directly related to losses from the institution's participation in TennCare, the state's program for the poor and uninsured. Losses in TennCare alone last year were $16 million and Vanderbilt continues to be the state's largest provider of services to TennCare families.

In addition to TennCare, Vanderbilt's health plans continue to show steep losses.

"Our financial condition is worrisome," Jacobson said. "Because of it, we must be able to reduce our cost-per-discharge below last year's rate. Reports are that Baptist and St. Thomas hospitals ‹ our principal competitors ‹ have, because of their own losses, cut back dramatically over the last several months. It's also been rightly reported that Vanderbilt has been able to weather the current storm because we have effectively reduced our costs in the past.

"We have all of you to thank for that. We've learned to work more efficiently and your attention to quality and patient satisfaction continue to make us one of the most sought-after health care providers in the region," Jacobson said.

Efforts to reorganize VUMC's clinical enterprise around Patient Care Centers gained momentum this year. Business plans were completed for about half the centers ‹ Trauma, Behavioral Health, Cardiology, Emergency Services, Women's Health and Children's Services.

Also during the past year, plans for several new building projects were revealed. In addition to the new Children's Hospital and a 4,200-space parking garage on 25th Avenue North, plans are in the works to construct a new office building to house administrative functions and a new facility, to sit on top of the hospital garage next to Medical Center East, for the Vanderbilt Bill Wilkerson Center.

Nowhere is the need for additional space more pressing than in VUMC's research mission, which is projected to expand dramatically alongside the projected increase in the National Institutes of Health's medical research budget. Current plans call for the construction of a new research facility on 21st Avenue North between the Learned Lab and the School of Nursing that will be shared with university researchers. Possibly the first project will be the construction of a new tower in the courtyard of Medical Center North.

"These projects should fill our short-term needs, but in the long run we are studying the possibility of a new research building at the south side of Medical Center North along Garland Avenue," Jacobson said.

VUMC's research mission is one of the things that sets the institution apart from the region's other health care centers. Tomorrow's medical therapies are born from today's scientific discoveries, Jacobson said.

"When we met last year, I spoke to you about our aim to be among the top 10 medical centers in the country. It is with this kind of support that we can begin to interest the best and brightest researchers to bring their intellect and energy here."

"The rational pursuit of better medicine is what we're all about and what makes us different and special. Unlike other health care institutions, we don't use our resources to buy physician networks or pay dividends to shareholders.

"We use our resources to promote better medicine; to train the next generation of health professionals; to devise new and better ways of keeping us healthy; to solve the most perplexing and frightening problems in medicine; and to bring those discoveries to the bedside of patients in need," Jacobson told the audience.

"That is what we're here for and on those days when it just seems like you can't stand it anymore, take a moment and remember that what you do is part of a great enterprise."