Is the Coming Forum an Approaching Storm or Another Sun
Shower?            April
1, 2013

By Leonard Zwelling

            On
Thursday afternoon, the faculty has been invited to a special forum by the
Faculty Senate. The President and other leaders will be discussing the linked
issues of clinical productivity and financial performance with the faculty.
This only makes sense as the vast majority of the capital needed to run our
$3B+ operation is derived from clinical revenue. If the clinical revenue is not
sufficient, the ability of the institution to meet its payroll, refit old and
construct new buildings, and air condition all of them will be in jeopardy.
Thus it is imperative for us all to use that A/C and remain cool as these
clinical targets and the dependent financial ones are explained to us.

            What
are the key questions? This is really quite easy:

1.     What
is the current state of our actual revenues from all sources and what is the
relationship between those revenues and the ones anticipated by the leadership
when the budget was constructed last fiscal year?

2.     What
is the current state of our expenditures on EVERYTHING, and what is the
relationship between this number and what was anticipated?

3.     If
these budget estimates and the actual performance do not align, why not and how
do we make the needed changes in the clinical operation to improve financial
performance?

            It’s
that last one that seems to be the point of the biggest contention. As I have
written in this space before, the leadership views the actual $20M operations
budget shortfall about which we have heard and read as a function of the
faculty not seeing sufficient numbers of new patients. This implies that we are
in the widget business and we are not making enough widgets. We would be fine
if we ran the widget assembly line faster.

            The
faculty has a different view or rather series of views. One is that the new MD
Anderson patients they are being asked to care for are not new cancer patients,
but are complex patients with an established cancer diagnosis who are no longer
responding to conventional therapies. These people have come to us to make
their cancer history and unfortunately that is not likely to occur.

            These
putatively “new” patients take an inordinate amount of time to work-up, the
work-up is associated with a great deal of expense which may or may not be
reimbursed depending on the patient’s payer, and these new patients are often
too ill to really help all the much and certainly too ill to be eligible for a
clinical trial. There is also a contingent of faculty quoted in the latest
Cancer Letter who believe the extra money their efforts is generating is being
used in fashions into which they have had no input and about which they have
grave doubts.

            The
leadership views this as a problem in operations and volume. The faculty views
this as a problem in quality made worse by inadequate infrastructure and strategic
planning into which they have had no input. These are two highly varied views.
It will be important to know which is correct before attempting to implement
solutions.

            These
issues are very important to determining the kind of place MD Anderson is to be
in the future. It should be obvious that it is imperative that as many faculty
members as can attend do so on Thursday evening and they should make their
concerns known. The leadership has taken the offer from the Senate seriously.
That would best be demonstrated by the leadership if it did far more listening
than talking on Thursday. But the faculty have to show their support for the
various positions by standing up as well. Questions that you may have can be
channeled anonymously through the Faculty Senate office and there will be
opportunity for face-to-face interchange with the leadership. If you really do
not like the direction that the institution is taking or even more importantly,
if you do, and think that the leadership is doing a good job and getting a bad
rap, for goodness sake show up.

            If
we allow this opportunity to pass us like a spring shower, shame on us. Rather,
we should bring a storm of questions, protest and support to the forum and see
what happens.

            “You
don’t need a weatherman to know the way the wind blows”—Bob Dylan

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