That's the $60,000 question, or maybe it's the $60 billion question. Raised a few years ago when it became clear that clinical revenues and Medicare subsidies were at risk because of managed care and efforts to balance the national budget, it's been hovering at the state capitol and in Washington, D.C. ever since. Over the past few weeks there has been movement toward a solution that brings both good and bad news.
The good news comes from the state legislature, which has made an excellent beginning by putting $8.5 million into a new GME trust fund. I applaud the governor, the Commissioner of Health, and members of the Minnesota Education and Research Committee (MERC) for efforts that led to this. And I appreciate ongoing efforts to calculate costs of graduate medical education, which now extends to other health professions, and to find new ways to support it.
The news from Washington, D.C. is less heartening. A bill proposing substantial cuts in Medicare reimbursement for GME is working its way through Congress. If it passes, this proposal will mean a loss next year of about $5.7 million at Fairview-University Medical Center alone and $20 million system-wide for University GME programs. These losses would come at a time when we have made long-term commitments to residents and fellows, when clinical revenues that support education are continuing to decline, and when health systems are asking to be paid for teaching that has been pro bono until now.
The Medicare law recognizes the value of medical education and pays participating hospitals for direct and indirect costs of medical education. We understand the pressures to make cuts in the Medicare budget. And we agree with cuts in DME (direct medical education) funds, which cover salaries, intended to limit numbers of physicians trained. We have already enacted a three-year plan to reduce GME enrollment, particularly in certain specialties, by 25 percent. But we do not think that medical schools and teaching hospitals can or should have to make the proposed cuts in indirect (IME) costs that cover the overhead of providing training.
Like our own state legislature, Congress needs to take a thoughtful look at the big picture rather than just making cuts in the Medicare budget. Simply cutting avoids the core issue: who is responsible for financing graduate health professions education? I have submitted several recommendations to the House Ways and Means Committee for more responsible actions. They include:
Federal funding reductions cannot and should not be offset by state support. If the federal government isn't going to pay for graduate medical education through Medicare, they should take responsibility for finding other sources. If the quality of health professions education declines because no one takes responsibility to pay for it, then everyone is going to pay.
That's bad public policy. But it's one answer to the $60 billion question.
-Frank B. Cerra
AHC Provost
The state legislature took an important first step toward reviving languishing funds for graduate medical education (GME) last month with an $8.5 million appropriation for the new GME trust fund.
The next step is for the state-appointed Medical Education and Research Committee (MERC), which recommended the trust fund, to devise a plan for distributing the money to teaching hospitals and clinics. Training sites for the AHC and Mayo Clinic, the largest medical teaching entities, are expected to be the major beneficiaries. Plans call for sending checks out to the sites, including Fairview University Medical Center, beginning Jan. 1, 1998.
The money is a one-year appropriation taken from the general fund ($5 million) and the health care access fund ($3.5 million), but the legislation also recommends transferring $15 million from the state's pre-paid medical assistance plan (PMAP) into the GME trust fund beginning in January, 1999. Money from PMAP could be used for the GME trust fund on an ongoing basis. While PMAP rates were structured to subsidize GME, the new plan will distribute the money more equitably to GME providers. The state will seek matching federal dollars.
The legislation also makes it clear that GME refers to a broad spectrum of health care professionals, not just physicians. The trust fund will provide graduate training for dentists, nurse practitioners, pharmacists, and physician assistants as well as medical interns and residents. Subsidies will pay for clinical training in both outpatient and inpatient settings.
MERC was created by the legislature in 1993 to find alternate sources for graduate medical education because existing sources-clinical revenues and Medicare subsidies-were at risk. The legislation stated that "the cost of medical education and research should not be borne by a few hospitals or medical centers, but should be fairly allocated across the health system."
The committee, which was appointed by the commissioner of health, includes representatives from education and research institutions, health care providers, health systems, insurance companies, employers, and consumers. AHC members include Sandra Edwardson, nursing dean; Michael Till, dentistry dean; Ron Franks, dean of the Duluth School of Medicine; William Jacott, head of family practice and community health; and Marilyn Speedie, pharmacy dean.
Feds propose cuts in Medicare subsidies
Meanwhile, in Washington, D.C., federal legislators are considering cuts in Medicare subsidies for graduate medical education that would mean a loss of $5.7 million for education and training at Fairview-University Medical Center and $20 million system-wide next year.
In essence, the bill, which was drafted by the subcommittee on health of the House Committee on Ways and Means, proposes reducing subsidies for indirect medical education (IME) by about two percent over two years (7.7 percent to 5.5 percent by 1999), cutting direct medical education (DME) subsidies by limiting FTE residents to the number enrolled on December 31, 1996, as well as phasing in cuts in DME overhead and payments to supervising physicians. IME refers to indirect costs associated with residency training. DME subsidy is salaries to residents and physicians who train them, as well as some hospital overhead costs. Another component of the bill is an incentive plan to encourage hospitals to voluntarily reduce numbers of specialty residents.
The bill also makes recommendations for looking into long-term considerations regarding teaching hospitals and graduate medical education. These include a a model for spreading costs among payers; effects of competition on teaching hospitals; dependence of medical schools on clinical revenues; and projected need for the number and type of health care professionals needed over the next decade.
Another provision is to use a competitive process to identify "centers of excellence" to provide specialized care, such as organ transplantation, to Medicare beneficiaries within a geographic region. The centers would also be specialty training sites.
Congress is expected to vote on the proposed legislation this summer.
-Peggy Rinard
Alook at each school or college's graduating class shows the growing diversity in the health sciences professional programs. The most dramatic shift is in gender. Women make up 75 percent of veterinary medicine graduates, 70 of pharmacy graduates, and 66 percent of the School of Public Health's graduating class. There's also an increasing number of older students, who are changing career directions in their 30s and 40s, as well as students of color, such as members of the Hmong community.
Here are some compelling stories about a few of those graduates.
Laura Olson, M.D.,
Imagine that you have a strong desire to be a physician, but you're a thirty-something mother with four children and you live on a farm in rural Minnesota.
Most people would try to ignore that kind of urge. But Laura Olson didn't. She enrolled at the Medical School, commuted to classes from Hutchinson, Minnesota (a 120-mile round trip) for four years, and earlier this month received her medical degree.
"I love medicine, so it didn't seem like an ordeal," she says. "I also had a lot of support from my family. My husband and kids were wonderful, my mother-in-law helped out, and I took it one day at a time."
Olson, who already had a B.S. in animal science from the U and a nursing degree from Mankato State University, decided to pursue medical school when she read a newspaper article about the need for physicians, especially women physicians, in rural Minnesota. She did an internship in Glencoe through the Rural Physicians Associate Program, and will do a residency in family practice in St. Cloud.
Laura's energy level remains high, but her 1993 Plymouth Voyager, which logged 144,000 miles on I-94 over four years, gave out a few days after graduation. "The transmission went out, but it's still a good solid car," she says. "I think I'm going to get it fixed and keep driving it."
Michele Strachan, M.P.H.,
Michele Strachan was focusing on the big picture of health long before she came to the University of Minnesota to earn her M.P.H. in maternal and child health, even long before she became a pediatrician.
Her resolve that health goes beyond antibiotics and CT scans goes back to her childhood in Haiti, where her father served as minister of public health. And it's this public health approach to medical care that forms the foundation of her goals.
"My aim is to make true change," says Strachan, who came to the United States in 1963 at age 12. Rather than "plugging holes in a sieve," we need to think of the bigger picture of health, beyond a healthy body to a person's spirituality, sense of community, and culture. These, she says, are "the glue that helps us move through life."
A graduate of New York's Mount Sinai School of Medicine, Strachan has worked on pediatric issues with the Save the Children Federation, served on the faculty at Columbia-Presbyterian Hospital in New York, and, here in the Twin Cities, helped enhance services to runaway youth of diverse cultural backgrounds. It was while working on a fetal alcohol syndrome project for the Indian Health Service that the cultural aspects of health care became resoundingly clear to her. Her next stop was the School of Public Health, where her thesis focused on spirituality in health care.
Today the community-initiated Powderhorn-Phillips Cultural Wellness and Health Education Center is where "it all comes together" for her, Strachan says. The center offers training to community members and to health care professionals seeking a greater understanding of the links between culture and health. "This is my present and my future," she says. As director of medicine, she assists clients in self assessments of their health and devises programs "to reconnect the community and the culture."
Phu Huynh, D.D.S,
Although Phu Huynh says he feels like your average School of Dentistry graduate, his path to graduation was anything but.
He's faced language barriers, culture shock, and, perhaps most dramatic, repeated attempts to flee his native Vietnam in search of freedom. In 1988, his final attempt proved successful - but not before he spent 16 days aboard a fishing boat, adrift in the ocean without food or fresh water. The following year, at age 23, he was admitted to the United States, where he attended the University of Washington.
Offered early admission into the University of Minnesota's School of Dentistry, he came to Minneapolis to pursue his dream of a health profession that combined patient contact with independence in his practice. The school's reputation as well as a particularly good program for minorities also drew him to Minnesota, he says. His next move may be back to Seattle, where he hopes to join a general dentistry practice and eventually open his own.
"I dreamt of the day I could hold my diploma," he says, "and when one of your dreams comes true, it's a very sweet feeling."
Darcy Gerard, B.S.,
As a 32-year-old single mother who had left her accounting job to attend the School of Nursing, Darcy Gerard wasn't a typical homecoming queen contestant. But she thinks that may be why she won the title in the U's 1996-97 competition.
She entered the contest as a way to become more involved in the life of the University, which she realized, as she approached graduation, was passing her by.
"I really didn't expect to win," she says. "I thought it was a chance to meet people and develop public presentation skills."
But the homecoming committee liked the mature perspective she brought to her interviews with them. "I think my age and life experiences actually helped," she says. "I also used problem-solving skills I learned in nursing school for the interviews, most of which were 'what would you do if?' kinds of questions."
Gerard will undoubtedly bring those skills to bear when she goes to work as a critical care nurse at Fairview-University Medical Center. She's thinking about pursuing a master's degree at the School of Nursing, possibly in nursing-anesthesiology, a new degree program.
Kendra Greiner, D.V.M.,
Kendra Greiner's first summer job at her father Ken Greiner's veterinary practice in Elbow Lake, Minnesota, was mowing the lawn in front of the building. This summer, she'll be working inside as a professional colleague.
"I've worked at my Dad's clinic since I was a kid. People used to say to me, 'you're going to be a vet just like your dad.' I just laughed, because I never thought I would. It was a little too close to home."
But Kendra began to feel an irresistible pull toward veterinary medicine in her second or third year as an undergraduate at the U, and gradually accepted her fate.
Unlike her father, who practices equine medicine, she chose to specialize in companion animals, however.
"I feel very drawn to the bond between humans and animals, and I enjoy working with people who love their pets and want to do anything to make them well," she says.
Kendra's presence will add a new dimension to the Lake Region Veterinary Clinic, where her father and three other vets provide care for horses and dairy cattle.
Michelle Grossman, Pharm. D.,
College of Pharmacy graduate Michelle Grossman gives her school perhaps the highest of all compliments when she says she received a great education and enjoyed herself in the process.
Starting this fall, Grossman will begin the job she's always wanted, thanks in part to her pharmacy rotations through the AHC's new Rural Health School. The program gave her the opportunity to work with medical, nurse practitioner, and physician assistant students as well as physicians "in a wonderful teamwork atmosphere," she says.
Grossman always intended to stay near her hometown of Cloquet in northern Minnesota, and all of her rotations will allow her to practice in the vicinity. This past spring, she completed a rotation at Mercy Hospital and Health Care Center in Moose Lake. This summer she'll be in Superior, Wisconsin, at a Veterans Affairs Medical Center coumadin clinic. Before her pediatric rotation this fall in Duluth, she'll help a College of Pharmacy faculty member set up a hypertension clinic on the Fond du Lac Indian Reservation near Cloquet. And later this fall, armed with a B.S. in pharmacy and her Pharm.D. degree, she starts the job she calls "everything that I wanted." She'll return to Moose Lake to work in the hospital's pharmacy, in retail operations, with nursing home patients, and with pharmacy students from the AHC.
Another part of her new job will be particularly close to her heart: She'll work with Moose Lake High School students in a health occupations program at the local hospital. Through this project, she hopes to serve as a good female role model for her profession, she explains.
-Gayle Bonneville
and Peggy Rinard
998 AHC students get diplomas
Caps and gowns, pomp and circumstance have been the order of the day as hundreds of AHC students received their hard-earned diplomas throughout the month. Here's a breakdown of this year's graduates by school. (Master's and Ph.D. candidates are enrolled in the University's Graduate School, not AHC schools, so some AHC colleges do not tabulate data on these students. Graduate School commencement is held monthly, and during the 1995-96 academic year 252 Graduate School students earned degrees through AHC programs.)
School of Dentistry
Medical School
School of Nursing
College of Veterinary Medicine
College of Pharmacy
School of Public Health
Faculty honored at promotion and tenure reception
A reception to honor 58 AHC newly tenured or promoted faculty was held in the atrium of the Basic Sciences/Biomedical Engineering building on June 10. Provost Frank Cerra presented promotion certificates. Many faculty brought spouses, children, and other family members. Entertainment was provided by members of the Health Sciences Orchestra.
"It is very satisfying to achieve this symbol of recognition for your work," said Linda Bearinger, associate professor of nursing. "I believe that tenure continues to be at the core of 'academic freedom' in that it acknowledges the faculty's rights to scientifically pursue areas of study, even when those areas are politically-charged. Without it, some areas of inquiry could be deemed too threatening to employment."
Leyasmeyer to head University Deans Council
Edith Leyasmeyer, Dean of the School of Public Health, has been elected chair of the Twin Cities Deans Council, which includes all deans on the St. Paul/Minneapolis campuses. Vice-chair since July 1, 1996, Leyas-meyer will begin her one-year term as chair the first of next month.
The council meets independently of the U's central administration, but works closely with the president and other administrators to provide perspective on critical issues. Leyasmeyer expects issues in the coming year to include the U's budget, substitution of O&M (operations and management) for ICR (indirect cost recovery) dollars, and identifying resources to pay for administrative information systems, including human resources, student services, grants management, financial management and technology infrastructure.
"This is a good opportunity for the AHC to have a voice with the president," she says.
Leyasmeyer succeeds Robert Bruininks, dean of the College of Education and Human Development, who will be executive vice president and provost in U president-designate Mark Yudof's administration.
Levitt honored with endowed chair and doctoral degree
Seymour Levitt, professor and head of therapeutic radiation-radiation oncology was honored May 21 with an endowed chair established in his name by colleagues and friends, who cited Levitt's "outstanding service and contributions to the U and to his specialty over the past 26 years."
The Seymor H. Levitt Clinical Radiation Oncology Chair will be filled after his retirement.
"I am honored by this chair, which reflects the many years of effort and faculty talent that have gone into building this department and as well as our knowledge about cancer," Levitt said.
Levitt received bachelor and M.D. degrees from the University of Colorado in 1950 and 1954. On May 24, he was awarded an honorary doctor of science degree from the University of Colorado School of Medicine. The award honors Levitt's long and exceptional career in medicine, and his instrumental role in shaping and advancing the field of radiation oncology.
Roby Thompson will be associate dean for clinical affairs in the Medical School. Thompson will continue as AHC Vice Provost for Clinical Affairs and his involvement with University of Minnesota Physicians (UMP). His new role will support alignment of AHC, Medical School, and UMP clinical activities.
The Minnesota Medical Foundation Golf Classic will be held Aug. 25 at Rolling Green Country Club in Medina. Last year's tournament raised more than $70,000 for medical research and scholarships at the U's Minneapolis and Duluth medical schools. Space is limited and the past few tournaments have been sellouts. Call 625-3136 to register.
Communicate with us. The AHC Office of Communications is looking for faculty, staff, and students to provide input for the AHC-wide communications plan. Volunteers are needed for focus groups to study and make recommendations for internal communications, community partnerships, communications technology, media relations, and legislative relations. The goal is to complete a draft communications plan by Aug. 1. More than 50 people attended an initial planning meeting on June 12. Call 624-5100 if you would like to participate.
Summaries of the weekly AHC Deans Council meeting minutes are now available on the AHC web site. Starting with the May 6, 1997, meeting, the postings are found under "AHC Office of the Provost Information - AHC Deans Council Minutes" or at http://www.ahc. umn.edu/dcm/
The AHC's Minnesota Biomedical Business Network - MBBNet - at
www.ahc.umn.edu/mbbnet has been posted on Yahoo!, the giant web index. The MBBNet link, under Business and Economy:Companies:Biomedical:Directories, is the only state-based directory listed, reflecting the size of the state's health care industry. AHC webmaster Bill Hoffman created MBBNet.
The 1997 Midwest Intensive Bioethics Course will be held June 22-26 at the Sheraton Minneapolis Metrodome. Hosted by the Center for Bioethics, University of Minnesota, the course is jointly sponsored by bioethics centers at the University of Wisconsin and the Medical College of Wisconsin. Sessions will focus on current issues in bioethics as well as history and theory. Continuing education credit is available. To register, call the Center for Bioethics at 626-9756.
AHC faculty presented biotechnology career options to high school students at "Biotechnology in Your Future," presented last month by the College of Agriculture, Food, and Environmental Sciences. Participants and contributors from the Medical School and College of Veterinary Medicine included Dan Mooradian, Allison Hubel, Jeff McCullough, Larry Schook, Alvin Beitz, Donald Otterby, David Thawley, Patrick Redig,Thomas Blaha, James Collins, and Kapur Vivek. Topics presented included artificial organs, DNA diagnostics, gene therapy, and food safety.
Top health economists from around the nation will converge on the AHC June 27-29 for the Eighth Annual Health Economics Conference, which will feature presentations on hospital competition, medical savings accounts, physician behavior and other diverse topics. Also on the program is a panel discussion on future directions in health economics research by Mark Pauly, University of Pennsylvania; Joseph Newhouse, Harvard; and Frank Sloan, Duke University. The Institute for Health Services in the School of Public Health is hosting the event, which is cosponsored by the Department of Veterans Affairs. Institute faculty who organized the conference are John Nyman, Roger Feldman, John Christianson, Bryan Dowd, and Willard Manning.
On June 5, the AHC-FCC and AHC University Senators took a bold step toward strengthening the consultative process by ratifying a constitution for an AHC Faculty Assembly. The Assembly, which will meet at least once each quarter, will have legislative authority over academic matters concerning more than one AHC school or college.
At the first meeting, Provost Frank Cerra, assembly chair, gave the group its first assignment-to provide feedback on three task force reports that address critical AHC problems: 1. Programs and Inter-Disciplinary Programs (PIDP); 2. Research Support Services (RSS); and 3. the Educational Service Organization (ESO).
The PIDP report identifies obstacles that inhibit interdisciplinary and intercollegiate collaboration and proposes a new and better process to support such efforts. The RSS report describes problems in the process for seeking industry-sponsored research and makes recommendations for improvements. The ESO report cites enormous changes in educational technology and delivery systems and proposes a plan for creating an umbrella organization that would provide instruction and services to faculty free of charge.
The FCC will coordinate the consultative process and communication with the
Provost. Faculty are encouraged to review the proposed initiatives and convey responses to their FCC representative. Copies of the reports are available on the AHC home page at http://www.ahc.umn.
-Muriel J. Bebeau,
WCCO-TV's June 8 "Dimension" segment featured the work of faculty in the School of Dentistry to correct dental deformities caused by the genetic disorder ectodermal dysplasia. Michael Till, dean of the school, was prominently featured in the piece which followed the progress of a young boy who now, thanks to the U, has a full smile. Steve Miles, associate professor of medicine, was quoted in the June 6 CityBusiness regarding the growing trend among local HMOs to establish ethics committees. Frank Cerra, AHC provost, said in a June 4 Pioneer Press article that Minnesota would likely not follow the trend toward for-profit hospital chains. Cerra was also quoted in the May 20 New York Times regarding the struggle teaching hospitals face in strong HMO environments. Pratap Reddy, clinical professor of urology, discussed a non-surgical innovation recently approved by the FDA for treatment of benign prostate enlargement. Stephen Hecht, professor in the Cancer Center, spoke about the effects of second-hand smoke in connection with a lawsuit filed by flight attendants against the tobacco industry, a story covered on KSTP-TV June 2. Russell Johnson, professor of microbiology, appeared on KSTP-TV June 2 in connection with a story about tick-borne diseases. Johnson and Jesse Goodman, associate professor of medicine, recently received an NIH grant to continue studies on human granulocytic ehrlichiosis, a disease transmitted by the deer tick. Goodman was quoted in the May 30 Pioneer Press, where he explained histoplasmosis, an infection that hospitalized musician Bob Dylan. A transplant team led by David Sutherland took part an interstate pancreas surgery that made the AP wire and the Pioneer Press May 31. Surgeons in Kansas removed a man's pancreas, damaged by chronic inflammation, and sent it to Fairview-University. Sutherland's team removed functioning beta cell clusters and returned them to the Kansas team, who implanted them in the man's liver. The goal of the unusual surgery was to prevent diabetes. B.J. Kennedy, Regent's professor emeritus of oncology, spoke on Minnesota Public Radio's "Mid-morning" program May 30 about how far we've come in the fight against cancer. Dan Rose, clinical specialist in preventive sciences, appeared live on KARE-TV's morning show to talk about the basics of dental care. News that a collection of 14,000 hearts may find a new home in the AHC aired May 24 on WCCO-TV, and appeared in the May 28 Star Tribune and the May 31 Pioneer Press. Leo Furcht, professor and head of lab med and pathology, is in discussions with Allina regarding the possibility of moving the hearts from United Hospital to the U for research. The Bethesda Clinic was in the news May 22 when it re-opened following a move to a new building in St. Paul's inner city. Dwenda Gjerdingen, associate professor of family practice and community health, was pictured and quoted in the piece for her work supervising doctors training at the clinic. Jeff Kahn, director of the Center for Bioethics, was quoted in the May 16 Star Tribune and Pioneer Press regarding the government's apology to survivors of the Tuskeegee syphilis study. Kahn contributed to the 1995 report of the White House Advisory Committee on Human Radiation Experiments, following which President Clinton apologized to families involved in the Cold War radiation experiments.
-Teri Charest
Letters, opinions, and news items should be sent to: this thursday, Academic Health Center Office of Communications, Box 735, 420 Delaware Street S.E., or e-mailed to ahcweb@gold.tc.umn.edu. Tel: 624-5100.
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Publisher: Academic Health Center Office of Communications
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Meet the graduates of the AHC class of '97
Medical School
School of Public Health
School of Dentistry
School of Nursing
College of Veterinary Medicine
College of Pharmacy
74 D.D.S.
29 B.S. in dental hygiene
223 M.D.
34 B.S. in mortuary science
33 B.S. in occupational therapy
30 B.S. in physical therapy
28 B.S. in medical technology
5 M.S. in clinical laboratory science
98 B.S. in nursing
76 M.S. in nursing
7 Ph.D. in nursing
71 D.V.M.
46 Pharm.D.
34 B.S. in pharmacy
21 M.S., 4 Ph.D. in biostatistics
15 M.P.H in community health education
18 M.P.H., 11 M.S., 4 Ph.D. in environmental health
17 M.P.H., 3 Ph.D. in epidemiology
43 M.H.A. in healthcare administration
9 M.P.H. in health services administration
6 M.S. in health services research and policy
11 Ph.D. in health services research, policy, and administration
20 M.P.H. in maternal and child health
14 M.P.H. in public health administration
14 M.P.H in public health nutrition
Around the AHC
News Briefs
Faculty Consultative Committee:
Faculty Assembly forms
professor of preventative sciences
Media Watch
this thursday is published biweekly for the University of Minnesota Academic Health Center community.
Director: Christine Roberts
Editor: Peggy Rinard
Writers: Gayle Bonneville, Teri Charest
Design: Ted Crandall, University Printing Services