March 3, 2006

Jacobson outlines VUMC’s future path

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Harry Jacobson, M.D., delivers the State of the Medical Center address to a capacity crowd at Langford Auditorium Monday.
Photo by Dana Johnson

Jacobson outlines VUMC’s future path

With a “bold goal” to reinvest $300 million annually by 2016, Vice Chancellor for Health Affairs Harry Jacobson, M.D., told an auditorium packed with faculty, staff and students that he envisions Vanderbilt University Medical Center will be a far different place when it meets its ambitious 10-year goals.

Jacobson used the five elevate pillars as a roadmap when delivering his State of the Medical Center address Monday in Langford Auditorium. It was an upbeat message that included Vanderbilt's quest to be recognized among the nation's top 10 hospitals, schools and research centers as well as VUMC's push to become a Fortune 100 employer within the next two years, something an academic medical center has never achieved.

At the top of VUMC's financial pillar is a plan to realize $100 million in profits annually from each of three key areas: clinical enterprise, philanthropy and technology transfer.

The areas of clinical enterprise and philanthropy are currently realizing roughly $50 million each, although technology transfer has room for growth with its $10 million annual contribution.

The Medical Center is growing, as evidenced by consumer surveys from 1996 to 2005 that show Vanderbilt has become the preferred provider in Middle Tennessee and is lengthening its lead in the marketplace with respect to consumer preference, which has climbed from 7.8 percent in 1996 to 16.6 percent in 2005.

Along with that growth are the realities that VUMC has limited near-term capacity to expand inpatient beds and parking issues are a constraint.

One approach to address these issues will be to divert appropriate services off campus when it makes sense, Jacobson said. On-campus future improvements will include a third bed tower at Vanderbilt University Hospital, currently in the planning stages.

Jacobson acknowledged that some services and procedures produce larger margins while under-compensated and uncompensated care continue to strain VUMC's financial health.

With a 66 percent increase in self-pay patients, meaning patients without insurance, Jacobson said he is surprised to see that TennCare volume also continues to increase.

Self-pay patients have increased in trauma by 118 percent since revisions to Tennessee's TennCare program went into effect, he said.

“We will hit budget, but we will be short of our target and the reason we are not going to hit that target has to do with TennCare,” Jacobson said.

“This is the issue that has my attention and the attention of members of our leadership team.”

Jacobson proposed solutions including a new $50 million essential provider plan, a state funding mechanism for Level I Trauma Centers, and restoring federal disproportionate share payments to a level commensurate with programs in other states.

“If we had [a disproportionate share plan] in place today, we would not have the kinds of problems that you see with charity care,” Jacobson said.

The School of Nursing received several points of recognition during Jacobson's speech.

Partnerships with both Lipscomb and Fisk universities have assisted by adding roughly 100 nurses a year through a program in which Vanderbilt provides a scholarship to students committing to at least two years of service after graduation.

A $3.5 million renovation to the school's Godchaux Hall is under way and numerous VUSN programs, such as Vine Hill Clinic the Nurse Midwifery practice are experiencing considerable growth.

VUMC's turnover and vacancy rates for nurses are considerably better than the national average, with turnover at 10.8 percent versus 14 percent nationally and an 8 percent vacancy rate well below the national average of 21.3 percent.

Another nursing-related endeavor is the Medical Center's ongoing pursuit of Magnet Recognition, the highest level of recognition that the American Nurses Credentialing Center can give to health care organizations using Registered Nurses.

From an admissions standpoint the Vanderbilt University School of Medicine is seeing a 15 percent increase in applications, with roughly one in 16 applicants accepted and one in 40 choosing to attend Vanderbilt.

VUSM initiatives to attract diverse students are also having an impact, with 13 under-represented minorities in the class of 2009 and 19 enrolled for the class of 2010.

VUMC has the strongest NIH research award growth in the country at 20.4 percent and is exceeding projections in that area with $320 million last year and $425 million anticipated by fiscal year 2009.

A main focus of elevate is to improve employee and patient satisfaction.

From a patient perspective, a team triage approach instituted by the Emergency Department is allowing a physician to visit each patient within 10 minutes of their arrival.

Jacobson would like for VUMC to one day be viewed as a “national learning lab” for its team approach to health care in all areas.

“Not only is quality a core strategy for Vanderbilt, it is becoming a core strategy for all medical centers,” he said.

From an employee perspective, this year's budget set aside nearly $1 million for managers to distribute to employees in recognition of performance, although Jacobson encouraged those managers to “take advantage of this program” because only 14 percent of those monies had been used at mid-year.