Managing Patient Care

uring an era when many academic medical centers are faced with drastic choices in the organization and management of their faculty practice plans, the University of Miami is making a renewed effort to bolster its plan. Last spring the School of Medicine recruited the new managing director for its University of Miami Medical Group from a somewhat unlikely place—the Georgetown University Medical Center, which merged its university-owned hospital and clinical faculty with a regional hospital organization. Minor Anderson shares his initial impressions of the University of Miami’s patient-care programs with Jerry Lewis, assistant vice president for communication for the School of Medicine.

JL What kind of challenges do you face here that you might not have faced at Georgetown or elsewhere?
MA Most definitely the multicultural aspects of the marketplace, which are both a special opportunity and a special challenge for us. An additional challenge that all academic medical centers face is that historically our delivery of patient care really has been focused more on the physician than on the patient. Economic conditions were such that we didn’t have to worry about the business of medicine, and we concentrated more on teaching and research. That may not have been right, but it worked. Now, we have to realign some of our priorities so we can compete in the marketplace and deliver a level of service that is on a par with our level of medical care.

JL How do you begin to do that? Obviously you can’t turn things around overnight.
MA It is tough. First and foremost, we have to be sure that service is a clear priority throughout our organization. Dean John Clarkson and I have talked about various ways of doing that. Clearly it is high on his priority list. We’re painfully aware of our service problems. The approach I intend to take is to start with the issue of access, which is just a subset of the larger service issues. We are in an incredibly luxurious position in that we have more patients than we can easily accommodate. What we really need to do is to focus on the constraints to accommodating those patients—things like difficulty in getting an appointment, confusing signage, run-down parking garages, billing errors—all of which are part of the service continuum.

JL Aside from the physical changes to our environment and systems, you’re also talking about changing human behavior.
MA You’re absolutely right. It’s about changing the culture of our organization. You can’t just flip a switch and say, “I’ve changed it.” It involves recruitment, training, and retention.

JL Is this a typical problem for urban academic medical centers? Is there a good model that we can emulate?
MA That’s part of the challenge. There are 125 medical schools in the United States. Perhaps 60 percent of them are academic medical centers. There’s a popular saying that if you’ve seen one academic medical center, you’ve seen one academic medical center. Each academic medical center has its own idiosyncrasies and characteristics. We have to design a system that’s going to work for us given our patient population, employee base, and physical layout.

JL You mentioned that we are in an enviable position of having more patients than we can possibly see. Is that true?
MA Well that’s the popular belief. I’m testing that theory. I want to see if that is really the case or if our systems are just so problematic that the patients can’t get in. It certainly looks like we’re turning away patients. You can talk to virtually any doctor in this medical center and they’ll tell you the same thing. They have three-month waiting lists because there are just that many patients who need to be seen.

JL Have we been diligent enough in going into the community with our satellite centers?
MA The simple answer is no. Academic medical centers have a mission of service to the community, and our community has given us a lot of support. Dr. Robert Schwartz, chairman of family medicine, and I have talked quite a bit about this, and I think both of us would like to see a larger, more robust primary care and multispecialty network throughout the community. It’s good business, it’s good service, and it’s good mission to do that.

JL How do you define our community? What exactly is our market?
MA Unlike most metropolitan areas that are fairly circular, our market is longitudinal. We have the ocean on one side, the Everglades on the other side, and a strip of dense population that runs down the coast. Certainly for any tertiary and complicated care we should be drawing from as far south as Key West and well into Broward County, possibly West Palm Beach. That may account for 10 percent of what we do. For the other 90 percent of what we do, the rule of thumb that health planners like to use is that patients will drive 20 minutes to see a primary care physician and 30 minutes to see a specialist. We need good solid market research to help us assess that.

JL What about the International Health Center? What are our opportunities there?
MA The sky really is the limit. The International Health Center has grown nicely in the past couple of years. Because of our geography and our diverse character, we are ideally situated to capture the Caribbean Basin and Central and South America for many services. Miami is a second home to many people who live in those regions.

JL What characteristics are you finding here that are similar to Georgetown?
MA Like Georgetown, our medical school is the largest single unit in the University. The University of Miami also is a private university with a modest endowment. And we have a large and aggressive research component. But that’s where the similarities end. Georgetown owned its teaching hospital and got no public support at all. There was no state support, because there was no state. The District of Columbia couldn’t provide either regulatory or financial support—an insurmountable problem that Georgetown eventually had to confront.

JL What is one of the biggest misconceptions you have discovered here?
MA It’s amazing to me that people tend to slam the medical center’s location. I think we have an outstanding location. We’re right on the Metrorail. We’re right on Interstate 95, easy on and off. Everybody coming in from the airport has to drive right by our front door. We are not capitalizing on location.

JL What external factors make it more or less difficult to elevate our clinical practice to where you want it to be?
MA Clearly, and these are not prioritized, our relationship with Jackson Memorial Hospital, our teaching hospital, is crucial. We have to be able to interface smoothly and efficiently with Jackson. I’m also meeting with all of the CEOs of the top managed care plans we do business with. Those relationships are important in helping us understand how they view us; I’m not sure we’ve had solid relationships at that level before. And I’m getting to know our competition better, so I have a better appreciation of what we’re up against in the marketplace.

JL In terms of a private university with a medical school as large as ours, what role should we play in the care of unfunded patients in our community?
MA Academic medical centers have been heavily oriented to indigent care. The University of Miami is the rule when it comes to that, mostly because of geography and because of our close relationship with Jackson. No one would question that our physicians are the principal providers of indigent care in this community, and I couldn’t imagine that ever changing.