Dr. Harry Jacobson, vice chancellor for Health Affairs, speaks during the Fall Faculty meeting on Monday. (photo by Dana Johnson)
Jacobson asks faculty for help at fall meeting
Dr. Harry Jacobson, vice chancellor for Health Affairs, addressed the faculty Monday at the Fall Faculty Meeting in Light Hall and highlighted a series of achievements and a set of objectives to focus faculty attention.
Part progress report and part call-to-action, Jacobson’s presentation outlined a series of challenges.
Nursing Shortage
Fueled by an aging nurse population and declining pool of entrants, the competition for nurses has become intense. At Vanderbilt, units have been closed, as well as operating rooms, due to the nurse shortage.
Jacobson proposed aggressive measures to retain the nursing staff. Salary increases, accelerated recruiting, and intervention to reduce turnover are needed to help with this problem.
The incorporation of Advanced Practice Nursing will also help with this problem. Advanced Practice nurses are being integrated in practices with Vanderbilt physicians. A new Midwifery Clinic recently opened in Medical Center North. Sponsored by the Institute for Healthcare Improvement, the Vine Hill Clinic is the only nurse-managed unit in the 22-site study.
“Today in this country, we don’t know how to utilize this level of care,” Jacobson said. “With Vanderbilt’s great school of nursing, we should be taking the lead in this area.”
New costs
The nursing shortage, combined with increased spending for the Pediatric emergency department and other department support, has resulted in new costs totaling $16 million.
With the increased capacity, The Medical Center plans to build volumes and streamline access to offset the additional costs.
“If we’re going to reach our target, we are going to have to do some things,” Jacobson said. “Increasing volumes will do it. I’m calling on you to redouble your efforts and take advantage of our increased capacity.
“The good news is people want to come to Vanderbilt,” he added. “The bad news is we can’t accommodate them all.”
Another way to help curb the cost includes WizOrder, an electronic order system for physicians, which helps reduce the number of unnecessary tests for patients. “This is a real tool for us,” Jacobson said.
“We need to use good clinical judgment, informed by the latest and best clinical information,” he said. “We need to do the right thing and only the right thing.”
Research
Jacobson praised the staff for the growth in productivity of the Medical Center’s research enterprise. Overall, there has been a 23 percent increase from 1999 to 2000.
The Meharry-Vanderbilt Alliance has also benefited the research aspect of the Medical Center. Eleven new research grants totaling $7.42 million and 10 new training and curriculum development grants worth $7.17 million are a direct result of the Alliance.
In 1998, the Medical Center began a formal effort to increase research dollars to $350 million by 2008. “I’m convinced that we will reach that goal before 2008,” Jacobson said.
Vanderbilt continues to lead the effort in research compliance, according to Jacobson. Vanderbilt received an outstanding review after a recent NIH site visit. “We are ahead of many institutions in research,” he added.
Revenue
Net revenue per discharge is above budget during the first quarter. Vanderbilt is collecting over $11,000 net revenue for each discharge. The goal is $10,704 for each discharge. However, the cost per discharge is also over budget. The actual cost per discharge was $10,227, compared to the budgeted $9,500. The inflated cost has lessened the profitability of the clinical enterprise.
“We are still behind, but it is an improvement over the past years,” Jacobson explained. “We would like to reach all targets this calendar year, but we might not.”
Outpatient visits are slightly below target with 171,158 through September. Inpatient admissions also barely missed the target of 8,143 with 8,110 actual admissions. The actual case mix is above the target which, according to Jacobson, is a positive.
“This means you are admitting sicker patients,” he said. “And the severely ill tend to pay more.”
Based on the first quarter of fiscal year 2001, Vanderbilt will meet the budgeted goals. During the first quarter, there were 8,187 discharges, 154,773 ambulatory visits, and 16,385 emergency visits. The margin for the first quarter was $5.2 million of the budgeted $24 million.
A potential revenue booster is the new Williamson County Cool Springs Ambulatory Surgery Center, which opened in September.
The joint venture with the Williamson County Medical Center could also increase revenue. VUMC and Williamson County will jointly operate the hospital which will be leased from the county
Academic Enterprise
The average debt for Vanderbilt medical students is $84,000, according to Jacobson. To increase scholarship money, Vanderbilt has started a $50 million campaign. The goal is to reduce tuition for all students and continue to attract premier students.
A lead gift of $12 million has been pledged by Dr. Dixon Burns, a graduate of Vanderbilt. Jacobson added that an additional $8 million is being secured from other sources.
“It looks like we will start with $20 million. That’s not bad,” Jacobson said.
The addition of several new academic leaders has greatly benefited the university. Dr. R. Daniel Beauchamp was recently named director of the Section of Surgical Sciences. Dr. Arnold W. Strauss has been selected as the James C. Overall Professor and Chair of Pediatrics. Heidi E. Hamm, Ph.D., is the new chair of Pharmacology.
Negotiations are still underway to chair the Cell Biology and Neurology departments.
Facility Growth
Construction continues on the various new projects on campus. The initial design and development is complete for the Monroe Carell Jr. Children’s Hospital. Excavation is underway for the $150 million project that is expected to be complete in May 2003.
The $14 million addition of the Frances Williams Preston building of the Vanderbilt-Ingram Cancer Center is to be completed by June 2001.
The exterior walls are underway on MRB III, expected to be done by April 2002. The estimated cost is $95 million. The $25 million Vivarium project is expected to be complete by December 2001.
As part of the new $1 billion University Fund Raising Campaign, Jacobson said that the university is asking for 50 additional endowed chairs.
“We’re asking for $360 million in people and projects,” he said. “We want to invest in people and projects, not just bricks and mortar.”