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The Role of Boston University School of Medicine in Transforming Health Care . Boston University School of Medicine. Darrell G. Kirch, M.D. President and CEO, AAMC June 12, 2012. What is academic medicine’s historical legacy? . The Legacy of Abraham Flexner for Medical Education.

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darrell g kirch m d president and ceo aamc june 12 2012

The Role of Boston University School of Medicine in Transforming Health Care

Boston University School of Medicine

Darrell G. Kirch, M.D.

President and CEO, AAMC

June 12, 2012

five decades of medical school growth
Five Decades of Medical School Growth

Growth in U.S. Population, GDP, and Medicine 1960-61 to 2009-10

academia as a major provider of health care
Academia as a Major Provider of Health Care
  • AAMC-member teaching hospitals represent 6% of all hospitals
  • Their work represents:
      • 21% of all Medicare inpatient days
      • 28% of all Medicaid inpatient days
      • 38% of all hospital charity care

They provide:

      • 77% of all burn center beds
      • 39% of neonatal intensive care beds
      • 82% of all ACS-verified Level 1 regional trauma centers

Overall, AAMC-member teaching hospitals provide 23% of all hospital care

Source: AAMC Analysis of American Hospital Association Survey Data, FY2010

medical school revenue by source 126 fully accredited medical schools fy2010
Medical School Revenue by Source126 Fully Accredited Medical Schools, FY2010

Total Revenue: $87 B

Median Revenue: $491 M

Source: LCME Part I-A, Annual Financial Questionnaire, FY2010

boston university school of medicine revenues by fund source fy2011
Boston University School of MedicineRevenues by Fund Source, FY2011

Source: LCME Part I-A Annual Financial Questionnaire, FY2011


The Cauldron

Grants and


Physician and

Hospital Revenues

Tuition and Appropriations

Discretionary Fund

Clinical Care




…Followed by a Supreme Decision…

Corbis/AP Photo/Dana Verkouteren

euro crisis imperils recovering global economy oecd warns

Eurozone's turmoil threatens global economy

Euro crisis imperils recovering global economy, OECD warns

—Chicago Tribune

May 23, 2012

—Los Angeles Times

May 22, 2012

U.S. stocks slump as Euro drops to two-year low on Greece worries

—Wall Street Journal

May 22, 2012

crossing a dangerous line

$15 Trillion is equal to:

    • U.S. GDP 2011
    • U.S. Debt 2012
Crossing a Dangerous Line

Source: http://usdebt.kleptocracy.us/

health care spending
Health Care Spending

Source: CMS National Health Expenditure Data, 2012

a sobering comparison
A Sobering Comparison
  • If other prices had grown as quickly as health care costs since 1945…

A dozen eggs would cost


A gallon of milk would cost


A dozen oranges would cost


Source: IOM 2011, “The Healthcare Imperative: Lowering Costs and Improving Outcomes”

49 9 million americans are uninsured
49.9 Million Americans are Uninsured

That’s 16% of the total population, or the

equivalent of the combined populations of 24 states.

how much more do women pay for health insurance
How Much More Do Women Pay for Health Insurance?

Data not available

0% more or gender discrimination prohibited

1 – 25% more

26 – 50% more

51 – 75% more

76 – 100% more

With the Affordable Care Act

Without the Affordable Care Act

(starting in 2014)

Based on data for what 25 year old women and men are charged for premiums.

Source: National Women’s Law Center, “Turning to Fairness,” March 2012

deficits in access and outcomes
Deficits in Access and Outcomes

The risk of maternal death in high poverty areas is twice that of low-poverty areas.

  • In 1991, no state had an obesity rate higher than 15%. In 2010, every state did.    

45 countries have lower maternal mortality ratios than the US.

In 2011, health care costs increased nearly 1.5 times faster than wages.

Cancer patients who receive palliative care live longer than those who don’t . 

41% of adults in America had trouble finding the care they needed because of costs.

comparing health care
Comparing Health Care




Access to Care

Percent of adults with insurance

Prevention and Treatment

Percent of older adults who receive timely preventive care

Avoidable Hospital Use

Number of potentially avoidable hospitalizations per 100,000 Medicare beneficiaries

Health Outcomes

Number of deaths per 100,000 people that could have been prevented by timely access to care




Worcester, MA

Salem, OR

Boston, MA



Pittsburgh, PA

Arlington, VA



Memphis, TN

Abilene, TX


McAllen, TX

Source: The Commonwealth Fund

deficits in outcomes
Deficits in Outcomes

U.S. Comparison to Developed Nations

  • 2009 Life Expectancy

2008 Infant Mortality

2008 Adult Obesity*

  • Bottom Third
  • 4th Highest


  • 78.2 yrs compared to Japan at 83
  • 6.5% compared to average 4.6%
  • Over 1/3 of U.S. population
  • *Only 7 nations reported data on this indicator

Source: OECD Health Data 2011, June 2011

massachusetts health status
Massachusetts Health Status


U.S. Average

Life expectancy

80.1 years

  • 78.6 years

Infant mortality rate

(per 1,000 live births)


  • 6.8

Heart disease rate

(per 100,000)



Diabetes death rate

(per 100,000)


  • 21.8

Overweight/obese adults


  • 63.8%
  • Source: statehealthfacts.org
boston ma health status
Boston, MA Health Status

Source: Commonwealth Fund Scorecard on Local Health System Performance, 2012

boston ma health status1
Boston, MA Health Status

Source:  County Health Rankings & Roadmaps, Robert Wood Johnson Foundation, 2012

creating a true health care system
Creating a “True” Health Care System

American Attitudes

Care Model


Economic Model

Institutional Culture

rethinking our approach to the medical education continuum
Rethinking Our Approach to the Medical Education Continuum


Residency and Fellowships

Medical School


creating a true continuum of medical education
Creating a True Continuum of Medical Education

Residency and Fellowships

Medical School



creating a true continuum of medical education1
Creating a True Continuum of Medical Education


Residency and Fellowships


Medical School



completing the full cycle of research
Completing the Full Cycle of Research

Clinical Science Discoveries

Comparative Effectiveness

Basic Science Discoveries


Health Care and Prevention of Disease

Patient and Community Engagement



Delivery System Transformation

the new yorker
The New Yorker

Source: The New Yorker, February 2011

consensus on rankings
Consensus on Rankings

Chronicle of Higher Education October 27, 2011

toward a new excellence
Toward a New Excellence

“Old Excellence”

“New Excellence"

service learning
Service Learning

VA Boston Healthcare System