(PBN file photo)
Leaders of Rhode Island’s seven private teaching hospitals have joined with Brown Medical School in a call for increased funding of academic medicine.
“There is a crisis in academic medicine,” said Donald J. Marsh MD, Dean of Medicine at Brown Medical School and co-chairman of the newly formed Rhode Island Academic Medicine Coalition (RIAMC). “Teaching hospitals are the heart and soul of our state’s health care system, and these institutions are at risk.”
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The coalition was announced last week during a news conference at Hasbro Children’s Hospital in Providence. U.S. Sen. Jack Reed, D-Rhode Island was there to announce newly proposed legislation to provide an additional $17 billion annually for the country’s teaching hospitals.
Like virtually all hospitals across the United States, academic medical centers have felt the pinch from federal spending cutbacks in recent years. Operating margins have nearly evaporated as reimbursements from federal programs and private insurers alike have dwindled.
But officials from private teaching hospitals say that unlike public hospitals, their institutions face unique costs that create an even tougher financial environment. Doctors’ time is split among teaching students and fellows, treating patients and conducting the cutting-edge research generated at the state’s academic medical centers.
Moreover, teaching hospitals provide a disproportionate amount of uncompensated care – free services given to indigent patients. Of the roughly $100 million of uncompensated care given in Rhode Island in 1999, more than $70 million was provided by teaching hospitals, according to RIAMC. That problem is exacerbated by the fact that Rhode Island is one of only a half dozen states without a public acute-care hospital.
“Teaching hospitals are the first choice for patients with life-threatening illnesses in need of state-of-the-art care, and the last resort for people who cannot afford to pay for health services,” Marsh said.
But despite the multiple roles played by teaching hospitals, they are not reimbursed accordingly, coalition members say.
“These kinds of expenses are not being borne by state hospitals, but everybody in the state benefits from the education, the research and the patient access,” said Robert A. Urciuoli, president of Roger Williams Medical Center and co-chairman of the new coalition.
RIAMC includes Roger Williams, Rhode Island Hospital and Hasbro Children’s Hospital, Memorial Hospital of Rhode Island, The Miriam Hospital, Bradley Hospital, Butler Hospital, Women & Infants’ Hospital and Brown Medical School.
The coalition’s objective: to boost funding for the state’s teaching hospitals by educating lawmakers and community leaders about the importance of academic medical centers and the challenges they face.
To illustrate the benefits of academic medicine, officials used the example of Rhode Island resident Marjorie Campbell and her eight-month-old twins.
The babies’ lives were saved last summer through fetal surgery performed by doctors from Women & Infants Hospital and Rhode Island Hospital, in collaboration with the fetal-medicine program at Brown Medical School. Only a few programs in the United States perform the procedure, which corrected a life-threatening fetal blood disorder called twin-to-twin transfusion syndrome.
As financial pressures mount, hospital officials say innovative programs and technologies, such as the surgery performed on Campbell’s twins, will suffer.
“There’s no question that a number of our academic programs are being impacted by the reduction in support,” said Brown’s Marsh.
Faculty at teaching hospitals is spread thin trying to meet the triple demands of teaching, clinical research and patient treatment, officials say.
“The system is very fragile right now,” said Dr. Jack Wands, chief of gastroenterology at Rhode Island Hospital and a medical professor at Brown. Wands called the doctor-researcher hybrid a “dying breed.”
“It’s unfortunate because doctors who do their own research have the advantage of being in the lab and learning the latest technologies,” Wands said. “They are able to bring that technology to the bedside.”
