BALTIMORE--Academic medical centers must now operate in a health-care environment that "has become increasingly unfriendly, even hostile economically," said former New England Journal of Medicine editor Arnold S. Relman, MD.
Those institutions that do not respond with dramatic changes risk perishing, a panel of participants in the battle agreed at the annual meeting of the American Association for the Advancement of Science (AAAS).
Indeed, it appears that some financially weak institutions will fail, no matter what. Based on his studies, David Blumenthal, MD, suggested that early in the next century, a large majority of the nation's 125 academic medical centers, through down-sizing and other changes, "will look more like medical schools of 30 years ago, before Medicare."
Dr. Blumenthal, chief, Health Policy Research and Development Unit, Massachusetts General Hospital, believes that many centers will survive, "but the question is, will they continue to do what academic health centers have done in the past." He added: "I don't think it is unrealistic to expect that 10% of academic medical centers and medical schools will not be around in 15 years."
The main problem threatening academic medical centers and their employees is declining clinical revenues, largely the result of managed care policies.
Private insurers and the Medicare and Medicaid programs are shifting patients to less expensive community hospitals, limiting hospital stays, and demanding discounted fees for physicians', inpatient, and outpatient services.
This has cut clinical revenues, which academic centers have long used to help off-set the costs of fulfilling their teaching and research roles, and drastically reduced or eliminated their ability to subsidize the care of indigent patients by shifting some of their costs to patients with private and government insurance.