Let’s face facts: even though folks who read this magazine presumably hold the research process in high regard, the phrase “academic research hospital” probably doesn’t sound as exciting as, say, the mow-down spirit of Wall Street or the Tyson-Holyfield match. But think again. In today’s free-for-all health-care market, academic hospitals-which conduct the research that undergirds high-tech medicine, educate new doctors about the latest techniques, and apply those tools and methods to rich and poor patients alike-are battling to maintain their financial strength in the face of competition from for-profit hospitals. Exciting?
“A little too exciting,” says Samuel O. Thier, president and chief executive officer of Partners HealthCare System. That nonprofit Boston-based organization includes two of the largest and most respected teaching hospitals in the country, Massachusetts General and the Brigham and Women’s, as well as three other teaching hospitals and a network of more than 750 separate primary-care doctors. “You have to remember that this isn’t a game; we’re talking about health care for people.”
Thier, former president of the National Academy of Science’s Institute of Medicine, spent three years as president of Brandeis University before taking the reins of Massachusetts General and creating the Partners system, which had revenues of $2.1 billion in its fiscal year 1996.
Technology Review senior editor Laura van Dam recently asked Thier whether-and how-to maintain the traditional missions of academic hospitals.
TR: Some critics say that the competition among hospitals today stems from rising health-care costs that in turn have partly come about because every hospital has felt obliged to acquire and use high-priced medical technologies such as MRI (magnetic-resonance-imaging) machines. Does the development of new technologies help or hurt financially?
THIER: To assume that technology raises health-care costs is silly. Depending on the particular technology and its use, it can cost more, save money, or be neutral. Look at the lithotriptor, a shock-wave machine that costs $1.5 million and blows up kidney stones. Previously surgeons had to remove kidney stones from patients who then might stay in the hospital four or five days and could be out of work for a month. With lithotripty patients go home the same day and are back at work in two days. That means major savings to the economy.
Partners HealthCare has just formed the Center for Innovative Minimally Invasive Technology, which is developing ways to improve diagnoses and treatments with less trauma to the patient. That can translate into fewer medical problems, which in turn can reduce the time patients have to spend in hospitals. Whereas we used to open the abdo-men to remove somebody’s gall bladder, with minimally invasive technology we can now take the gall bladder out through a little tube called a lapar-oscope. We’re also doing research with a new MRI unit that lets surgeons operate on the brain while they’re looking at MRI images. Previously surgeons couldn’t do both tasks at once. That made brain surgery trickier and sometimes longer.
Maintaining the level of medical-technology research we’ve had is important in this era of managed care. Already, physicians in the regions with the highest penetration of managed-care facilities show a fall-off in clinical-research publications and grants. This suggests that doctors are being pulled away from those responsibilities to see more and more patients.
I’m not saying managed care is bad-in fact, Partners is all for it and very much takes part in it-but it should not be used to promote the lowest-cost care at the expense of research on better treatments.