I've been thinking a lot about Clayton Christensen's comment that the traditional general hospital is not a viable business model, and especially so for general hospitals that are also academic medical centers. I'll have more on the business implications of that conclusion in a future posting, but I want to take a moment to explore one ramification. It occurred to me during a panel discussion with Harvard Pilgrim's Charlie Baker and health care consultant Jeff Krasner (seen here) at the Convergence Forum a few days ago.
People often comment on the fact that a lot of discoveries made in academic medical centers result in new diagnoses, therapies, and devices that add to the cost of health care. And that is true. Our society does not generally conduct a cost-effectiveness analysis on new developments in the field, focusing mainly on medical efficacy and, indeed, business viability. But it is also true that academic medical centers are the place where the creativity of physician-scientists goes to work every day to develop ideas that can really make a difference.
Our Chief of Radiology, Jonny Kruskal, recently told me about a recent example. One of our young radiologists, Ivan Pedrosa, had a hunch about how to deal with the tricky diagnostic problem of pregnant women with pains in the lower right abdomen, which might or might not be appendicitis. Ultrasound does not give a reliable answer, and CT scans are problematic because of radiation. Ivan believed that use of MRI might produce more reliable answers than the former and with less chance of harmful side effects than the latter. Following some experimentation, he and his colleagues were able to prove the hypothesis and publish their results. The study has now been widely circulated (for example, here), and this approach is now expanding as the new standard of care.
Please accept my non-doctor apologies if I don't have the story and the science exactly right, but I think the point is clear. There is a societal advantage to have academic medical centers like BIDMC, as places where many medical advances occur -- often unreimbursed by insurers and the government. That contributes to the lack of viability of our business model, along with the many other factors mentioned by Clayton, but it makes more urgent the question that derives from Clayton's analysis. How do such centers survive and thrive in the environment of disruption he has so ably described?