January 31, 1997

New VUSM elective created to de-mystify managed care

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Dr. David Charles

New VUSM elective created to de-mystify managed care

It isn't enough any more for medical students and residents to merely know the human anatomy, ailments associated with each part and how to treat those ailments.

Today's physicians in training must not only know the differences between CTs and MRIs, but also HMOs and PPOs. And what exactly does Point of Service mean?

This spring Vanderbilt University Medical Center will begin an elective course to teach medical and nursing students, residents and faculty about managed care, which will involve lectures, computer-based self instruction and small group/ward teaching.

The endeavor is being led by the Vanderbilt Medical Group and developed by Dr. P. David Charles, assistant professor of Neurology.

Charles has received a grant from the Harvard Macy Scholars Institute Program for Physician-Educators for the project and recently spent 10 days in Boston learning how to implement the program.

"When people talk about managed care, we all hear a word salad of phrases. But what do the phrases mean and what do they mean to Vanderbilt?" Charles asked.

"Managed care is the minority way we deliver care throughout this entire region. It's a minority of the care delivered at VUMC, but it's the fastest growing segment," he said. "We have sought to align ourselves in a way that we can compete effectively for managed care contracts and we now have a primary care base that's second to none, but our physicians and nurses don't have sufficient training in the principles of managed care. It's essential that we have an educational program not only for residents, but for our entire faculty."

In June of last year, the Resident Physician Section of the American Medical Association House of Delegates called on every residency training program in the country to offer education in the principles of managed care. Vanderbilt's program was already being developed.

Charles said that the traditional model of teaching at every medical center is departmentalized. Once a student finishes medical school, the remainder of the student's education is taught in a particular department.

"There are no courses that cross those departmental lines," he said. "If Vanderbilt is to be competitive in this market all of us, regardless of our departmental affiliations, must learn the principles of managed care. These include active collaborations between our departments."

Charles, Dr. Corey M. Slovis, professor and chair of the Department of Emergency Medicine, and Roxane Spitzer, associate dean of the Vanderbilt University School of Nursing, will coordinate the educational program for the three groups.

Educating the faculty is essential to the success of the project, Charles said.

"Housestaff can't apply knowledge and skills they don't see demonstrated by their faculty attendings. Health care, more and more, is delivered as a team approach, so it doesn't make any sense to target one group. The target has to be Vanderbilt University Medical Center as a whole."

Charles said the endeavor is "daunting." There are over 650 fulltime faculty members, 620 fellows and residents and 400 medical students.

"Ultimately, the success of the program will be seen by evaluating our performance."

Charles said the purpose of the training is twofold.

First, Vanderbilt must be able to compete for managed care contracts. And second, when students and housestaff finish their training, it is essential that they come away with an educational background involving managed care, because, Charles said, "Immediately, they'll be presented with a contract to join an HMO or a practice and they won't even know who the players are and how it all works," he said.

This new educational program at VUMC will help change that, Charles said.

"When physicians are trained at VUMC, they will come away with the knowledge and skills and hopefully attitudes that will make them a quality physician," he said. "But to practice in today's environment they must also have an understanding of health care finance and the principles of managed care.

"When the incoming housestaff finishes, they'll leave here with a solid foundation in health care finance and the principles of managed care so they will be competitive for positions in private practice or academic medicine anywhere in the nation."