基于绩效的战略投资:一个更加一体化的医学院/教学医院资金流的演变
医学院(SOM)与其主要教学医院之间的关系已经并将继续成为学术医疗中心(AMC)的基础要素。. Through their collaborations in education and research, SOM和教学医院能够在患者护理市场中脱颖而出,并将其地位和地位提升到无法独立实现的水平. However, 这两个实体的所有主要资金来源所面临的压力和不确定性从未像现在这样大, resulting in increased scrutiny on the financial underpinnings of the relationship. 管理学院的领导和教职员工质疑教学医院提供的支持水平,以换取所提供的云顶集团和学术品牌的价值, 与此同时,医院的高管们也在努力确定医院流向学术合作伙伴的数百万美元的价值和投资回报率(ROI). As described in our introductory publication on AMC integration,1 当前的环境要求更现代的从属关系安排,以描述相互责任和伙伴关系所产生的价值.
管理学院和教学医院之间的财务安排包括无数的交易, but they essentially may be defined as (1) purchased services or (2) strategic investment.
……实现更大整合和协调的机会在于建立在业务规划原则基础上的投资策略,[并]与业绩保持一致.
Purchased Services. These include services that most hospitals, either academic or community-based, must secure, such as medical direction for clinical programs/units and coverage for key clinical services (e.g., anesthesia). Indeed, 教学医院和som(通常与教师实践计划相结合)通过联合评估和决策,在改善购买云顶集团的问责制和透明度方面取得了重大进展. Medical directorship effort and performance expectations are more defined, and the individuals filling those roles are rewarded or replaced based on specific criteria. Similarly, clinical coverage requirements and attendant payments are more formula-driven, flexible, and grounded in fair market value principles.
However, 这种购买云顶集团方法的演变尚未完全发生在研究生医学教育中。, an area that greatly impacts AMCs. The presence of GME programs define a “teaching” hospital, with significant value realized through the related academic brand, the clinical coverage provided by residents and fellows, and the built-in physician recruitment pipeline. Financial arrangements for GME, though, 通常是基于医院从政府支付者那里收到的直接GME报销和/或历史上的“整体拨款”预算的传递, neither of which may represent the true cost borne by the SOM.
Following the lead of other purchased services agreements, GME项目指导和教学的费用应与FTE要求(通常由ACGME明确定义)和项目绩效预期(例如.g., match rates, board certification pass rates). 与管理GME项目相关的其他费用的支持也应该是基准驱动的和公式化的.g., 确定每个居民的支持)在激励成本管理的同时提供一致性和可预测性.
Strategic Investment. 教学医院对其SOM合作伙伴的学术努力的战略投资充满了模糊性和不确定性, despite its importance to both parties. 这种金融格局通常包括当前领导团队之前的历史交易的大杂烩, unsubstantiated deficit support, and promises of funding that only materialize in part (or not at all). Moreover, 只有在非常有限的情况下,管理学院和教学医院的效益和绩效与这些安排有关. A zero-based approach to strategic investment is often required, with a standardized business plan process applied to each investment opportunity. 对于需要启动和/或持续支持的关键任务项目,一个满载的预算(例如.e., faculty physicians, midlevel providers, support staff, and non-personnel and indirect costs) must be clearly defined, as should the financial contributions from the hospital and SOM to offset these expenses. Projections for financial performance, faculty effort across missions, 生产力也必须包括在内,以便各方了解承诺和期望. Finally, 在预期的资金来源没有实现或生产力水平没有达到预期水平的情况下,风险分析和随之而来的补救计划是必要的. 这可以防止“财政悬崖”突然使一项关键的项目投资脱轨,并将SOM和教学医院置于决定哪个实体将提供额外支持的位置.
另一个必须继续发展的战略投资要素是教学医院为管理学院的学术人员提供的自由裁量或任务支持. 这笔资金由SOM院长全权负责分配给关键任务项目(包括基础科学项目),使AMC具有“学术性”. In many AMCs, this type of support has never existed, and in those where it has, the payment has often taken the form of an above-the-line block grant. 更进步的amc正在将自由裁量的学术支持与教学医院的表现结合起来.
Furthermore, as with the program-specific investments described above, 院长必须通过业务规划和监控流程,向教学医院和管理学院的教师清楚地传达他/她是如何投资这笔资金的. The outcomes from such an arrangement are truly in the win-win category, with both entities having greater predictability regarding levels of discretionary funding, SOM的教师清楚地看到他们在教学医院的贡献如何与学术联系起来, and the teaching hospital demonstrating a commitment to the academic brand of the AMC.
虽然许多资产管理公司已经提高了教学医院和管理学院之间存在的购买云顶集团协议的清晰度和客观性, 实现更大的集成和一致性的机会在于以业务规划原则为基础的投资策略, is in line with performance, and has discretionary academic support at its core. 这是一种基本的机制,可以在临床和学术项目之间灌输一种共同的目标感,并加强学术品牌,使AMC与那些试图侵蚀其市场份额的社区竞争对手区分开来.
Footnotes
- 1.
ECG Management Consultants, “AMC Integration – Five Points of Opportunity for Real Alignment,” June 2012.
Published November 14, 2012