January 2001  Volume 2   Number 5

A MESSAGE FROM THE DEAN
Never before have we faced the myriad external challenges which exist today. The threats are real and the stakes are high. No threat is greater to our clinical enterprise and to the overall success of our missions than compliance with government standards in documenting, coding and billing for the patient care we provide. We live in a world of regulations which are often complex, confusing, and perhaps even contrary to our educational mission and what we believe is quality patient care. At the same time, we must work to eliminate unnecessary clinical documentation requirements which serve only to support billing. Healthcare fraud is the second highest priority of the U.S. Depart-ment of Justice. Penalties for failure to comply can amount to tens of millions of dollars and potentially result in exclusion from participation in Medicare, Medicaid and other federal health care programs. Univer-sity Physicians, Inc. (UPI) has established a comprehensive compliance program to educate our faculty and staff on government requirements, and to monitor practice activities. This year alone we will spend close to $1 million on this effort. Each practice group has a compliance liaison and the UPI board of directors has established a compliance committee to oversee the program. Increases in administrative expenses and reductions in reimbursement also threaten our existence. The key to our success must also include continued monitoring of the payer market and vigilance in our administrative operations. In the last two years we have proven our vigilance, with record clinical revenues of $98 million and $105 million in FY99 and FY00 respectively. The Clinical Affairs Committee (CAC) and Financial Affairs Advisory Committee (FAAC) provide critical oversight to assure that our resources are used in a fiscally prudent manner and are focused on those activities which will best serve our overall missions. Revenue and redesign efforts within UPI have also succeeded with improved performance tracking by our practices and third party payers, as well as significant improvements in the training of clinical staff to meet the oftentimes burdensome administrative requirements imposed by the government and managed care plans. We cannot afford to lose the revenue to which we are entitled because we have failed to meet required payer standards or because of a breakdown in our own internal processes. This revenue is critical to meeting our educational, research and clinical goals. We will continue to look at so called “dashboard indicators” such as days in accounts receivable, lag in entry of charges, and claim edits and denials, and we will also endeavor to automate and integrate activities further where this would improve patient experience and practice performance. Compliance is also a critical matter in our research activities. There is		substantial government scrutiny being applied to assure that government research funds are spent appropriately, that government payers do not reimburse for the patient services that are already covered by research grants, and that human subjects are appropriately protected. Research is critical to the success of our institution. In the most recent data compiled by the Association of American Medical Colleges (1998-99), the SOM ranked 9th among all public medical schools in research funding, and 24th among all 125 medical schools. Our faculty received awards totaling $172.6 million in FY00, which accounted for 45% of our budget. The federal government has moved to strengthen human subject protections in the wake of highly publicized events in which human subjects were not appropriately protected. Increased expectations and requirements include investigator education and credentialing, ongoing internal auditing, data safety monitoring plans for all clinical trials, and broadening the scope of substantive review by the convened Institutional Review Board (IRB). In order to meet these new requirements and expectations while maintaining timely and efficient IRB review, I have allocated additional resources and staff to the Office of Research Subjects. We will shortly double the number of IRB committees from two to four. Education programs and credentialing are in place, quality assurance auditing has begun, and the transition process from paper to electronic submissions is continuing. Service on the IRB is critical for the research enterprise of the SOM and all clinical faculty will be expected to participate. Today’s environment is the most challenging we have ever faced. Excellent results – whether in the academic, research or patient care arena – are not enough. We must fully document what we do to charge for services rendered and to avoid large paybacks or fines for noncompliance. We must follow the maze of administrative requirements and track payers to ensure payment. Research activities must fully protect subjects and meet all clinical, accounting, and administrative standards. Excellence in these areas will enhance our educational mission, set a sound example for our students and residents, and improve the overall experience for our patients. We have done much to promote these goals over the last several years, but much remains to be done. With the continued diligence of all faculty we will continue to thrive in this dynamic environment. (left to right) Sean Fox, first-year medical student, Bridget Hilliard, second-year medical student, and Jen Simpson, first-year medical student, and a little helper take a break from volunteering at the 11th Annual Spirit of Thanksgiving Dinner & Clothing Drive held Thanksgiving Day at Booker T. Washington Elementary School. Over 400 turkey dinners were served to the needy of West Baltimore.