The COVID-19 pandemic has inflicted individual pain and mass suffering in a just few short months and while the rate of spread in Colorado seems to have plateaued, it will continue to be with us for months to come. Today marks the initial small steps to resuming care for non-emergent conditions but it is clear that it will take some time to get back to ‘business as usual’ and that some aspects of health care delivery will be permanently changed by this experience. Our frontline providers have valiantly cared for the sick and our campus community has rallied in countless ways to support them. Still, we face an unrelenting pair of crises – a pandemic without boundaries and an economic crash of historic proportion. As a result, we now face painful decisions as we work to preserve the future viability of the University of Colorado School of Medicine.
Last week, CU President Mark Kennedy announced: “Given the uncertainty and negative budget trends, it is prudent for us to plan for budget reductions. Our mission and values will guide decisions....Only mission critical hiring will move forward. All budgetary decisions will be made with the best interests of students and the state in mind.”
The CU School of Medicine is experiencing, as are multiple segments of our economy, unprecedented economic stress. Due to deferment of non-emergent care, our clinical revenues are substantially reduced, as are those of our hospital partners whose partnership with us includes substantial economic support. All indications are that the state budget for FY20-21 will have to be substantially reduced. This loss of clinical revenue, which is roughly two-thirds of our budget, compounded with the anticipated reduction in partnership and state support, has produced a substantial budget deficit. In our case, we cannot afford to wait until mid-May to start making difficult decisions.
While we are one School, our departments are each responsible for their own financial performance. As a result, department and center leaders in the School of Medicine were asked earlier this month to begin a thorough review of their operations to assess the financial impacts of the pandemic and economic downturn. We are currently reviewing plans submitted last Friday that are tailored to the specific circumstances of those departments and centers. School leadership will be working with those units to ensure the plans adequately address the gravity of the circumstances and find the proper balance of ensuring the viability of our operations, our mission to serve our community, and our commitment to our faculty and staff. We will not be able to take care of others if we do not take care of ourselves.
Some cost-reducing decisions at the School of Medicine have already been made. The Senior Associate Deans and I are voluntarily taking significant compensation reductions, as are the Department Chairs and leadership teams in many departments. Annual merit increases for School employees that had been scheduled to take effect in July have been suspended. The School of Medicine has paused hiring except for mission-critical positions. The University is currently restricting work-related travel and discretionary spending.
Other decisions still need to be made. The School and its departments will have to consider furloughs, layoffs, and other options to ensure that our expenses more closely match our work productivity. As we adapt to ongoing needs to maintain social-distancing requirements, we also need to think critically about our hours of operation to ensure proper social distancing for those reporting to offices, clinics, and laboratories. We need to make sure that job assignments match with the needs of our work spaces. If the day’s tasks, for example, are grant writing or data analysis, we will need to continue work-from-home options.
These decisions will need to be made soon and the review will need to be continuous. The process of making the budget for the next year must also address decreased revenue projections and incorporate an altered economy. Sustained high unemployment is likely to increase the number of people who depend on Medicaid for their medical care. We are hopeful that federal officials will recognize that need, protect existing funding to that program, and ensure that any supplemental funding is used directly for the care those people deserve.
We are not alone in making such painful decisions. Mayo Clinic announced earlier this month that it is projecting a $3 billion loss this year and to stave off an even worse loss, it is instituting across-the-board pay cuts and furloughs. Last week, Johns Hopkins University said its projected financial results for the year swung from a $72 million positive margin to a net loss of more than $100 million, so it unveiled a substantial package of salary reductions for university leaders, salary holds for faculty and staff, suspension of retirement contributions, restrictions on hiring, and rounds of substantial furloughs and layoffs. Washington University in St. Louis said it faced a decline in revenues of $60 million in just the first month of the pandemic, and as a result, it has taken several steps to reduce expenses, including freezing non-clinical positions on the medical campus, eliminated merit salary increases, furloughing 1,300 employees for a period of up to 90 days.
None of us are immune to the consequences of the hardships. As a School, we have been striving to shield our employees from sudden shocks to their income, but we will not be returning to normal conditions in the near future. Researchers are working hard to find therapies and to develop a vaccine for this coronavirus, but we are not there yet. And while physical distancing measures adopted by our state and large parts of the country have helped suppress the spread, there are efforts to relax those protective measures. As those conditions are relaxed, absent an effective therapy or vaccine, we should expect an increase in the number of COVID-19 cases. Any re-opening of our campus must take into account the health and safety our faculty, staff, students, and those we serve, so we are addressing many challenges as we ramp up our activities while maintaining a safe workplace. In May, we will continue the gradual process of reopening some campus laboratories and we will responsibly increase elective patient visits and procedures. There will be new ways of conducting that business – entrance checks, required masks, floor coordinators to ensure social distancing. As we move forward, we will need to respect one another’s space and add patience to the many other virtues we bring to our work. Chancellor Don Elliman announced on Thursday, April 23, that a pilot phase is expected to start this week.
Our resolve has been and will continue to be tested by the pandemic and the economic turmoil. Our campus has banded together to provide the best care and to find the best solutions to the most difficult problems and, while the magnitude of this one exceeds any that we have experienced in our lives, we will succeed in this effort. Thank you for your ongoing compassion and commitment to excellence.
The health care providers on the Anschutz Medical Campus were honored last Thursday evening by first responders who looped through our campus in their vehicles flashing lights and sounding sirens. The parade included police officers, firefighters, and other law enforcement officials who passed by UCHealth University of Colorado Hospital, Children’s Hospital Colorado, and the Rocky Mountain Regional VA Medical Center next to our campus. It is especially meaningful to have these heroes offer their salute to the courageous teams on the frontlines in the hospital.
Stephanie B. Gold, MD, assistant professor of family medicine, and Larry A. Green, MD, professor of family medicine and Distinguished Professor of the University, at the Eugene S. Farley, Jr. Health Policy Center, are co-authors of an issue brief on the need for immediate payment reform to sustain and improve primary care. The brief calls for implementation of the Medicare Primary Care First model or other adaptations of value-based care, with similar guidance for state Medicaid agencies. The model would allow prospectively paid, risk-adjusted per member per months payments that allow clinicians to provide proper primary care and adapt to challenges. The brief notes that COVID-19 is causing practices to transform the way they provide care, which will require payment flexibility that is not available under traditional fee-for-service systems. Their co-author on the brief, published by the Milbank Memorial Fund, is former CU faculty member Jack Westfall, MD, MPH.
Heather Gilmartin, PhD, NP, and Bethany Kwan, PhD, MSPH, who are researchers with the Colorado Clinical and Translational Sciences Institute (CCTSI) have created a survey to understand the impact of remote work on your health, your research, and your teams. The five-minute survey asks you to share your remote work experience and best practices. Responses will help researchers and institutions adapt to remote work during COVID-19 and inform planning and future policy decisions. Follow this link to the survey. For more information on the project, go to the CCTSI Dissemination and Implementation Research page.
In late March, a team of researchers led by faculty of the CU School of Medicine, published an article in The New England Journal of Medicine that outlines the results of a major study of rivaroxaban in patients with peripheral artery disease who had undergone lower-extremity revascularization. The study covered more than 6,000 patients to determine benefits of rivaroxaban. The study found that in patients with peripheral artery disease who had undergone lower-extremity revascularization, rivaroxaban at a dose of 2.5 mg twice daily plus aspirin was associated with a significantly lower incidence of the composite outcome of acute limb ischemia, major amputation for vascular causes, myocardial infarction, ischemic stroke, or death from cardiovascular causes than aspirin alone. First author of the article is Marc P. Bonaca, MD, MPH, associate professor in the Division of Cardiology and executive director of CPC Clinical Research, an academic research organization affiliated with our campus.
Sana Karam, MD, PhD, assistant professor of radiation oncology, has been named the ARRO Educator of the Year for the University of Colorado Radiation Oncology residency program. Sana was selected by the residents to recognize her commitment to education, mentorship, and professional development. Each year, ARRO, which stands for Association of Residents in Radiation Oncology, presents the award to one outstanding faculty member at each participating institution.
Kathleen Flarity, DNP, PhD, associate clinical professor of emergency medicine, deputy director of the CU Anschutz Center for Combat Medicine and Battlefield Research and a Colonel in the U.S. Air Force Reserve, has been named the recipient of the 2020 Mary T. Klinker Award by the Aerospace Medical Association. She is also mobilization assistant to the Air Mobility Command Surgeon, Brig. Gen. Robert J. Marks, and is a research nurse scientist at UCHealth. The award is given annually to recognize significant contributions and achievements for aeromedical evacuation, en route care, and combat medicine. Several elite military senior leaders from nursing and medicine have received this award spanning the Vietnam War, Operation Desert Shield/Storm, and the conflict in Iraq and Afghanistan.
Thank you again to all who are putting in extra effort at this challenging time. Remember to take care of yourself so that you are in the best condition to take care of others. Here are websites with information and resources for members of the CU Anschutz Medical Campus community:
School of Medicine COVID-19 Informational Resources: https://som.ucdenver.edu/COVID-19
Coronavirus Research Guidance: https://www.cuanschutz.edu/coronavirus/research-guidance
Anschutz Medical Campus updates: https://www.cuanschutz.edu/coronavirus
Division of Infectious Diseases: https://medschool.cuanschutz.edu/infectious-diseases/information/ncov
Department of Psychiatry: https://medschool.cuanschutz.edu/psychiatry/covid-19-support
Health and Wellness: https://anschutzwellness.com/resources/
Have a good week,
John J. Reilly, Jr., MD
Richard D. Krugman Endowed Chair
Vice Chancellor for Health Affairs and
Dean, School of Medicine