MD Anderson: From C-Quester
to Sequester                                                                        February
27, 2013                 

By Leonard Zwelling

                  Most
of the members of the MD Anderson faculty are on a journey—personal and
professional, individual and collective. Each wants to fulfill his or her goals
of producing meaningful work in his or her chosen field be that basic science,
population-based research, clinical research, clinical care or education or
even some combination of these. But until recently there was also a
communitarian sense of doing good together and serving a larger cause. Each
faculty member was on a quest but as a member of a crew of a cancer fighting
ship. Let’s call that ship the C-Quester for it contains a crew on a quest for
the answers to the Big C.

                  Today
the C-Quester has been mothballed, a fallen victim of its namesake the
Sequester and I don’t mean the one in Washington although the problems causing
the sequester here are the same as the ones there—too much spending.

                  The
sequester that went into effect in Washington on March 1 is essentially a
series of spending cuts brought about by an idea President Obama thought would
surely bring the Republicans to the “grand bargaining” table. He figured that across
the board budget cuts would be so painful that Congress would have to forge an
agreement to increase revenues and decrease spending that would both cut the
deficit and contain the pain. Uh-oh! Following the fiscal cliff 11th-hour
deal that increased revenues, the Republicans refused to fall for that again
and said either real controlled spending cuts to entitlement programs will go
into place or they will allow the sequester, painful though it may be, to take
effect. And that’s what has now happened.

                  It’s
happened here at Anderson, too—twice. Both in 2008 and recently, the leadership
of MD Anderson (the same players but with different presidents) once again
demanded that the clinical faculty up the revenue stream—the local equivalent
of “taxing the rich” in DC. Spending cuts? Not a chance. IACS grows. The moon
shots grow. The packages to new hires grow. Construction continues. But
surprise, just as in DC, you simply cannot push the revenue side alone without
some attention to the spending side and both here and in Washington that has
yet to occur.

                  We
await the details of what the DC sequester will mean for the country. The
suspicion is that on one hand those unaffected will say a 2% cut should be easy
to handle. But the civilian workers on military bases who are furloughed and
the janitors on Capitol Hill cleaning the offices vacated by Congress for a
long weekend who might sustain a 10% pay cut will feel the pain of the federal
sequester.

                  My
guess is that the janitor equivalents here will be non-tenured faculty first
soon to be followed by a host of administrative layers and eventually tenured
faculty considered non-essential. You might say fine to the decrease in the
size of administration until your grant is swallowed by a black hole that used
to be a grant expert who was working furiously to take up the slack caused by
the malfunctioning Resource One and the other shortcomings in our institutional
IS that have been plugged for years by people, because leadership simply denies
the deficiencies in infrastructure.

                  That
building that looks like a boat is full of dedicated employees who used to be
the valiant crew of the C-quester. The next time you go looking for one of
them, don’t be surprised if they are on shore leave.

                  The
MD Anderson admiralty has yet to rise to the occasion and realize that the
revenue stream will be lucky to stay where it is given the saturation of the
hospital and clinic’s capacities and the decrease in reimbursement likely to
envelope the health care marketplace. The Medicaid expansion might also be
harmful to the bottom line if these patients who formerly could not get here
now occupy the beds and templates and displace the well- insured. The recent
Time Magazine article by Steven Brill amply demonstrates the order of magnitude
difference between what government insurers pay us vs. what private insurers or
the non-insured pay.

                   Only through a careful planning process
that develops a new strategy for Anderson, right sizes it accordingly and
curtails spending to a level that is sustainable by the revenue stream that is
somewhat aligned with reality will the Good Ship C-Quester return to the high
seas with a happy crew of high morale and smooth sailing ahead.