In contrast, funding from state and local agencies has been flat, and funding for NIH research has declined when adjusted for inflation. Resistance to growing tuition and fees, another important revenue source, is increasing. Ms. Marks reviewed the challenges related to managing NIH resources and maintaining adequate funding in academic medical centers. She also discussed the probability that clinical revenues will decline due to changing physician employment models, the increasing view of healthcare as a commodity, and the shift of costs to consumers.
Ms. Marks also reviewed the political, economic and demographic forces that will profoundly affect academic medical centers across all three missions. Political interventions to address the rising costs of medical care will profoundly impact the economic, demographic and market forces that support academic medical centers. She stressed that external sources may be unwilling to subsidize fundamental principles of the academic medical center, particularly education and research, and we must be creative in addressing these challenges.
Members from Vizient discussed how relative value units (RVUs) are developed and applied to compensate physician productivity. Recently Vizient merged with the Faculty Practice Solutions Center (FPSC) to serve many academic medical centers and acute care hospitals across the country through provision of data on RVUs, patient charges and evaluation and management coding distribution. They discussed how RVUs were developed and applied to measure clinical productivity. Data were presented that revealed a decrease in earned work RVUs in rheumatology practices, from 5,126 in 2011 to 4,256 in 2015. Moreover, a five-year trend suggests a 17% overall decrease in the work RVU production. Explanations for this decrease are unclear but may relate, in part, to the use of electronic medical records.
Timothy Laing, MD, senior associated chair of clinical programs at the University of Michigan, and Musty Habhab, chief administrator in the Department of Internal Medicine at the University of Michigan, discussed the use of RVUs in managing rheumatology divisions. They described how the total RVU comprises the work RVU plus the practice expense RVU, plus the malpractice expense RVU. The work RVU includes time, technical skill, physical effort, mental effort, along with judgment and psychological stress. RVUs can be applied to manage a rheumatology division, to assess productivity, to deliver provider compensation and for billing reviews. Details regarding the use of RVUs in provider compensation and billing reviews were presented.
Richard Siegel, clinical director at NIAMS, closed the meeting with a discussion of the rheumatology training pipeline. Data from the FIT Survey revealed a paucity of trainees interested in basic, translational or clinical research. The survey also found that clinical educator and clinical investigator tracks were preferred among women and that one of the major factors influencing career decisions is the high student debt carried by many U.S. medical school graduates.
