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View from the Hess Institute 2018

 , August 24, 2018

Translating Health System Finances to Departments and Divisions: Show Me the Money

Dr. Gregory Rouan, MD is the Taylor Professor of Medicine and chair, Department of Internal Medicine at the University of Cincinnati College of Medicine and UC Health.

The role of a chair continues to evolve over time and is dependent, to some degree, upon local norms and governance and operational constructs of their academic health center. If leaders are to succeed in these matrixed organizations, they at least need to be informed, adaptable, accountable and collaborative. Drs. Gregory Rouan, Thomas McGinn, and Gary Rosenthal have a combined experience of 20 years as chairs in their respective departments at the University of Cincinnati (UC)/UC Health, Hofstra University/Northwell Health, and Wake
Forest University/Baptist Health. They shared their insights regarding effectively working with their administrators and other leaders in their organizations during their Hess Leadership Institution presentation. Dr. Valerie Stone, chair at Mount Auburn Hospital in Boston moderated the session.

Highlights of the session included an appreciation of: (1) differences across academic medical centers and health systems in governance, structure, reporting relationships, and funds flow and how these differences impact departments and divisions, (2) the evolving roles and purview of the chair in their organizations to include service lines, macro-finances and funds flow, and (3) mission-based contributions of their departments.

Tying the contributions of each department to the missions of their system was noted to be a best practice for each chair. The retention of fellows and residents as new clinical faculty members in the health system, and the reputation of a department’s research enterprise were described as a way to bolster the credibility and viability of a health system, contributing to its margins.

Aligning with the health system’s priority of delivering advanced subspecialty care to the community based upon its affiliation with the Department and College of Medicine, Dr. Rouan described such a best practice from the University of Cincinnati with a $20+ million return on investment since 2013 based upon support of faculty research careers.

Dr. Rosenthal outlined clinical funds flow at Wake Forest Baptist Health based upon budgeted RVUs, hospitalist purchased services, rampup funds for newly recruited clinical faculty, and RVU productivity bonus. He also described research funds flow, again based upon salary for faculty and staff on external grants, research salary match, and research start-up and bridge funding. Finally, he outlined the basis for stipends of faculty academic and clinical leadership roles, administrative funds for staff support, chair and division chief startup
funds, and endowment income.

Dr. McGinn described the single unified governance and administrative and clinical leadership structure at Northwell Health. Its approach focuses on a service-line tactic to care delivery and integrated continuum of care and utilizes common, system-wide metrics. The system is committed to transparency, consumer and patient focus, and team-oriented care. He also described how Northwell is committed
to innovation and transformation.

Each related how they became department chair and encouraged attendees to consider this position. They described opportunities and challenges at their respective institutions and closed with a Q&A session. As chair roles evolve, coming together to review best practices will remain an important resource for leaders.

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