Fellow riders on my Moroccan bike ride a couple of weeks ago would often ask about BIDMC's clinical specialties. Without giving much thought, I would say, "The usual -- cancer, cardio-vascular disease, GI, orthopaedics, infectious disease, diabetes." But upon return, I realized I had shortchanged some of my colleagues. So it is time to set that aright, at least in part.
I just visited with George Tsokos, chief of our Rheumatology Division. In the short time since his arrival here in 2007, George has built Boston's largest Lupus clinical program. Systemic lupus erythematosus is an auto-immune disease that mainly strikes young women. It can be seriously debilitating. Its course is unpredictable, and treatment currently is focused on resolving symptoms, not reversing the disease itself.
George's group also has the region's largest research program. He and his colleagues study the cellular and molecular mechanisms of the disease and the mechanisms that lead to tissue injury. His aim is to identify molecular therapeutic targets and disease activity biomarkers.
He has plans to join with Martin Pollak, our chief of Nephrology, to create an interdisciplinary clinic. Why? Well, about 60% of people with Lupus show symptoms related to the kidneys.
George was recruited by Mark Zeidel, our Chief of Medicine, who saw a need for the Boston metropolitan area to focus on this disease. Interestingly, this was a humanitarian goal, as the reimbursement rates for physicians in this field are not very attractive. Diagnosis and treatment do not to involve procedures, so there is no significant gain for the hospital, either. When Mark approached me with this idea, I wholeheartedly supported it.
This is an important aspect of academic medical centers that is worthwhile for policy-makers and insurance companies to remember. While there are aspects of our clinical services that are well paid and produce a margin, there are others that make no money or lose money. But, for a young woman with Lupus, having a place to go and be seen by one of the world's specialists is very important. Mark and George make a persuasive case that this is sound thinking, even if it is not good business.
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3 comments:
Depends on the perspective....in a full risk environment, it could be a resource saver
I am currently pursuing a MBA/MHA at Georgia State University in Atlanta, GA. This semester, I am taking Strategic Management in Health Care. The book for the class, Strategic Management of Health Care Organizations by Linda E. Swayne et al. , mentioned your blog and how you used it to challenge other hospitals in the area to publicize their infection rates.
I tip my hat to you for taking a bold stand. Also, I read quite a few of your blog posts, and wanted to thank you for being accessible and taking the time to share your unique perspective.
One of my first patients as a medical student 35 years ago (good grief!) was a 16 year old girl with lupus who died of it. One does not forget these patients.
Also, during my practice I was friends with a couple of rheumatologists who regularly bemoaned the fact that they had not entered a procedure-based specialty.
Could there be better arguments for moving away from "fee for procedure"?
nonlocal MD
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