(Jan. 27, 2016) - University of Colorado School of Medicine Dean John J. Reilly, Jr., MD, on Wednesday delivered his first State of the School address, announcing multimillion-dollar investments in five strategic research initiatives, while also commending the faculty’s clinical success and financial support for the School’s research and education missions.
In addition, Reilly outlined plans that call for expanding clinical care throughout metro Denver, for ensuring the efficient use of research space on the Anschutz Medical Campus, and for dedicated preparation for the 2017 visit by the School’s accrediting body, the Liaison Committee for Medical Education.
The speech was a review of a successful year and a call to action to face several issues in the years ahead.
Reilly credited former Dean Richard Krugman, MD, and Lilly Marks, the University of Colorado’s Vice President for Health Affairs, for building “the escalator that I and many others have stepped onto,” and that has lifted the School of Medicine to position of strength.
“It’s from that foundation and from their leadership that I’m in the position to tell you where we are today and to paraphrase the President of the United States, the state of the union is really good,” Reilly said.
The highlight of the speech to a packed auditorium in the Hensel-Phelps West Auditorium and an overflow crowd in neighboring Hensel-Phelps East Auditorium was the announcement of five Transformational Research Funding projects.
Last September, the Dean released a call for applications for Transformational Research Funding, calling for faculty to submit proposals that would create multidisciplinary programs that will identify gaps in our current research capabilities and support the recruitment of talent to facilitate research of high impact. The original plan was to support no more than four proposals. Each proposal could have a budget between $10 million and $20 million over five years.
On Wednesday, Reilly announced proposals to invest in a Patient-Integrated Value and Organizational Transformation center, establish a gastro-intestinal and liver-related diseases program, create a Center for Human Immune Innovation, build and strengthen RNA biosciences, and start a Center for Fibrosis Research and Translation. (See related article with additional details on the selected projects.)
After announcing the selected projects, Reilly said: “So, you guys are all scientists. A lot of you are physicians and you can presumably all count. That’s five, not four. And that reflects the pressure that Peter and I felt.”
Reilly and Peter Buttrick, senior associate dean for academic affairs, convened an external review committee to evaluate the proposals.
“There are lot of worthy projects that we did not have the resources to fund,” Reilly said. “I think my job is to go out and try to identify the resources to capitalize on those other opportunities. That said, I’m very proud of these projects.”
The announcement of the projects came after Reilly outlined many successes and challenges ahead for the School.
Reilly welcomed new School leaders, including two Department chairs: Vesna Todorovic, MD, PhD, MBA, Department of Anesthesiology, and Brian Kavanagh, MD, MPH, Department of Radiation Oncology. Kathleen Barnes, PhD, joined the School as head of “the program with the most unfortunate acronym – BIPM,” standing for Biomedical Informatics and Personalized Medicine and said “Job No. 1 is to change that.”
“I’m happy to announce the new associate dean for diversity Shanta Zimmer accepted our offer last week and will be joining us later this spring,” Reilly said. “We were the beneficiaries of a two-fer on that one because it’s a dual-career recruit. Her husband Fernando Holguin will lead the Latino Health Research and Policy Program and have both clinical and research presence in the Center for Lungs and Breathing in asthma at University of Colorado Hospital.”
Zimmer, MD, is associate professor and director of the Internal Medicine Residency Training Program at the University of Pittsburgh. Holguin, MD, MPH, is assistant professor of medicine and pediatrics at University of Pittsburgh and assistant director of the Asthma Institute at UPMC Montefiore Hospital.
After announcing leadership additions, Reilly gave an overview of the School’s finances. He pointed to a graph showing relatively static state support and controlled tuition income and fast-growing revenue from the faculty practice plan.
“What you see is remarkable growth in the blue component of that graph, which is the faculty practice plan, which has become the economic engine that has allowed the values of the faculty be expressed in the way we run this enterprise,” Reilly said. “And it is truly remarkable growth. At a time when you talk to most of your colleagues around the country, most academic medical centers are struggling to hold on to their market share, let alone grow it.”
The faculty supports the School by providing funding through the Academic Enrichment Fund (AEF). That money is invested in equipment, faculty recruitment and School programs. Last year, the Academic Enrichment Fund provided about $36 million and since its inception, the AEF has provided nearly $385 million.
“I think it’s one of the remarkable things that many on this campus have come to take for granted, but I think is worth speaking about explicitly,” Reilly said. “What underlies the tremendous growth and excellence on this campus is the collective willingness of the faculty to invest in the mission and the most tangible expression of that is the Academic Enrichment Fund.
“The fact that we have clinical faculty who are willing to devote part of what would otherwise be their income to support research and education has been the engine that has fueled this growth and is not typical of all enterprises involving large numbers of doctors.”
He said the supportive atmosphere allows the School “to attract and retain really good talent.” As an example, he said he attended a lunch with medical students on Wednesday to recognize scholarship recipients. University Physicians, Inc., the faculty practice plan, provides about $350,000 per year in scholarships and is one of the largest contributors to the scholarship program.
“I think this says a lot about our culture. It’s very easy to say supporting things about the education and research missions. It’s a very different thing to invest substantial resources in it and it’s a remarkable thing about all of you and all the faculty on this campus that they’re willing to do so.”
Reilly also noted the strengthening of philanthropy in support of the School and he said it reflects a new approach under the leadership of Vice Chancellor of Advancement Scott Arthur.
Among other achievements noted by the Dean:
The first class of third-year medical students going to the Colorado Springs Branch will begin their studies there this April.
Health professional students are leading the way in community service operating the DAWN Clinic in Aurora.
Hire Local and other programs by the Community-Campus Partnership are strengthening bonds with the neighborhoods surrounding the Anschutz Medical Campus.The upcoming visit in 2017 by the School’s accrediting body, the Liaison Committee for Medical Education, will require great effort and attention.
“Having just participated in one of these site visits at another institution, I can tell you it’s a big deal,” Reilly said. There are 93 standards that the LCME uses to evaluate medical schools and “I can tell you that there are people at the LCME who can recite all 93 of them from memory.”
The School has established 13 committees to evaluate compliance with those standards and to ensure any deficiencies are addressed before the LCME’s visit.
One area of progress has been on issues of student and learner mistreatment, which Reilly credited to the establishment of the Office of Professionalism at the School. He said former Dean Krugman and Barry Rumack, MD, director of the office, have lead the way.
“We have seen demonstrable progress in those (student) surveys over the past two years,” Reilly said. “We have a ways to go before we’re at a place that we’re all happy with, but I think things are moving in the right direction.”
One of the biggest challenges ahead for the School is the shift in reimbursement to medical care providers.
“This is the thing that has everybody in America who works in health care thinking,” he said. “This transition from so-called volume-based care, or fee-for-service care, to value, or population health. The only question is how steep is the drop off for fee-for-service care and how quickly will value-based reimbursement come into effect.”
He said Medicare has a goal of getting to at least 50 percent of its reimbursement to value-based over the next 24 months. Such a major change will require a different approach to clinical care system design and delivery than has been the norm in American medicine up until this time.
Working with the School’s provider partners is vital to the future and UPI must adapt to keep up with changes in the health care marketplace.
Reilly noted that the School’s two biggest clinical partners – the University of Colorado Health System and Children’s Hospital Colorado – are already making changes.
“Over the past three or four years, they have embarked on a journey, transforming from being standalone single hospitals to being the epicenters of hospital systems. And part of the rationale for doing that is the emergence of population health and the need to provide a full spectrum of care over a broad geographic and demographic area.”
“By definition, those will involve our participation in a partnership. We are undoubtedly the largest multi-discipline practice in the state of Colorado. We have approaching 2,400 members in UPI and this will require a different set of business capabilities at UPI. Contracting in the context of clinically integrated networks is different than going out and doing what UPI has been phenomenally good at, which is negotiating provider contracts with third-party payors.”
One of the priorities will be to expand the faculty physicians’ physical presence off the Anschutz Medical Campus.
“We are running out of space,” Reilly said. “It’s hard to believe for those of you who moved out here from 9th and Colorado, but easy to believe for those of you who practice in the hospital systems that we are becoming facility-constrained here in terms of faculty offices, ambulatory practice space and in-patient beds. That’s an issue we and our partners are going are going to have to deal with and are in the short term, but it’s something that’s going to require more investment in the long term.
“We moved east to come out here to establish a campus. I think it’s time to look west. I think over the upcoming year for both the reasons of practicality in terms of facilities, but more importantly for reasons of patient access and population coverage, we have to have a clinical presence outside the Anschutz Medical Campus.”
Making way for additional laboratory space is necessary too. The campus is conducting a research space allocation study and will be rolling out possible options for using existing space more efficiently.
“You can’t do research out on the lawn, right?” Reilly said. “While it seems like we’re full in terms of our research space, by most reasonable metrics it would suggest that we have the capacity to add additional research space to our current facilities. What that’s going to mean is a reallocation of research space in some rational manner.”
It will be imperative “to not only free up square footage of available research space but to create it in a geographic pattern that allows contiguous plots of research space so that we can put investigators together who have good reason to be working together or are sharing common equipment.”
Reilly said the committee working on the project for the past year will soon roll out options.
“The hard part is talking about implementation and how to move all the jigsaw pieces, but this is an absolutely fundamental requirement for us to tackle if we are going to begin to take advantage of the investments we’re going to make in research. To bring new talent to this campus and to bring new programs means we have to put them in first-class space, so that’s going to be a priority.”
While noting the challenges, Reilly said the issues are the right kind to have.
“In closing, I would say the state of the school is very good. We’re in a great place and the problems we have are the problems of success and if you have to choose a set of problems to have, those are the ones that you would want.
“We have a great faculty. We have a great environment. People here are working very hard both subjectively and objectively and doing really good things. We deliver high-quality clinical care objectively measured and will continue to do so. We are more challenging than we should be to get to that high-quality clinical care and that will be a focus over the upcoming year.
“We’re doing really good science here and we have the opportunity to build on that and do even better science going forward and I hope that the investments will catalyze that activity. And I hope that all of this combines to make us the place where young people going into medicine want to come. We want the most talented young medical students and science trainees to come and participate with us on our campus.
“I think for us to sustain this in the long run we’re going to have to continue to have a productive alignment with all of our partners, most notably Children’s and the University of Colorado Health System. I think we are in a good position to put structures in place to help facilitate at that collaboration.”