Why I Am So Damned Angry-Fixing It-Part 2

Why I Am So Damned
Angry-Fixing It-Part 2


Leonard Zwelling

         So I defined the economics of academic health care in

short, it sucks.

are rising. NIH budgets are shrinking compared with science inflation.
Reimbursement for health care is falling. The drug companies are ever tighter
with their cash and more restrictive about what faculty can do with it. Our
friends in Washington keep the regulations piling on and won’t reverse the
damage HIPAA has done to research despite a 2009 National Academy of Sciences
report recommending to Congress that major changes to the law do so. And don’t
get me started about the knuckleheads that run your IRB. You all thought I was
a pain in the ass. I was an amateur.

         What to do?

         With regard to research, education and prevention, it is
quite simple. Make a budget that derives from the patient care and other net
positive income streams that is in accord with what the institution can afford
and stick to it. These mission areas are losers and you can only absorb so much
loss. (Please, Ellen Gritz, before you yell at me about prevention, remember, I
am on your side, but prevention is an economic luxury and a research jewel and
this discussion is about money).

         Well, that was simple. We dismissed three out of four
mission areas in an instant. Spend less.

         Patient care requires only one more decision. Decide what
the hell you are doing? This is a question in strategic planning. So here are a
few questions MD Anderson might consider answering prior to planning, if it
ever gets around to planning:

1.  What are you not going to do beside football and

2.  What if you limited all patients allowed in the front
door at 1515 to the ones MD Anderson can uniquely help or those who can
uniquely help MD Anderson (e.g., go on a clinical trial)? Everyone else goes to
one of the regional sites in Houston or beyond. You could strip away thousands
of jobs and millions of dollars in costs with this move alone. (And God knows
how many vice presidents.)

3.  Is the clinical org chart logical? No, it is not.
Division heads should run the entirety of their clinical enterprises and
nursing and clerks should be subservient to the faculty not the other way
around. Sorry, Barbara Summers, but doctors save cancer patients and nurses
help. The nurses in the suits help no one, so give me a break about nursing
research and nursing PhDs.

4.  Do we need a provost? Answer, no. We need a Chief
Academic Officer along the lines of Margaret Kripke who was a skilled
administrator of faculty matters meaning the equitable distribution of space,
slots and money. Stop with the presumptuousness of academic attire and
convocations. It’s a cancer center, stupid, not Harvard. Hell, it’s not even
Faber U., except for the double secret probation!

5.  Assign a CMO to run the hospital and clinics who
actually knows which end of a patient is up. Tom Burke qualified. There are
others. Tom Buchholz does not. He is a nice man, but an out-patient doctor only
and could not possibly understand the needs of the intensivists or the running
of an operating room. Being nice is not one of the CMO job descriptions.

6.  Dump Fontaine and Leach at all costs. Replace with
caution. Hire a CFO/accountant to manage the money, not make or spend it. Use
the R. Lee Clark model of the President deciding what to do with money. Someone
needs to call balls and strikes (CFO) and someone needs to play ball (President
and faculty). If you want a lawyer, fine, but limit his or her practice to what
he or she knows about—law, not the health care business.

7.  Time for a new president. This guy has so overstayed
his welcome, they are making him wash his own towels and sheets. Find a new job
for the wife as well. We have all had their nepotism up to here. They have
wrecked Aveo. Get them out of here before they wreck Anderson.


8.  Return to the R. Lee Clark model. Docs run Anderson.

That’s my 8 cents. You? 

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