University of Wisconsin Medical: Dr. Jeffrey Grossman, President & CEO

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Scanning the horizon at the University of Wisconsin, it’s  hard to miss the growth that has been occurring at UW Health over the past several years. “We have a circle of cranes around us,” said Dr. Jeffrey Grossman, Senior associate dean for clinical affairs at the University School of Medicine and Public Health and President and CEO of the University of Wisconsin Medical Foundation. But the obvious structural expansion isn’t the only way in which this academic health center and has grown and succeeded. It has developed internally as well, allowing for the physical growth those cranes are creating.

Foundations of UWMF and UW  Health

The University of Wisconsin Medical Foundation (UWMF), the University of Wisconsin School of Medicine and Public Health, and the University of Wisconsin Hospital and Clinics (UWHC) all work together in a strategic alliance to fulfill the missions of UW Health.  UWMF is the clinical practice organization for the faculty physicians of the UW School of Medicine and Public Health, who, through their delivery of clinical care, support the academic missions of the school. In combination with UWHC and other hospital partners, UWMF provides clinical sites, technical and professional staff and administrative services to UW faculty physicians.”

Financial success, founded on the delivery of superb patient care, was the first order of business, according to Grossman, when UWMF formed a little more than 10 years ago, and they have been pursuing that course ever since. “I take great pride in our organization’s ability to “do well by doing good”, to transform the fruits of strong clinical practice into a financial “engine” for the school’s academic missions. This 501(c)(3) corporation had a revenue base of over $480 million for 2007.

“As our clinical revenues have increased, we have been able to pay clinicians at competitive market rates while helping to underwrite the school’s missions of education and research, and also investing in programs that support the community,” Grossman said. Along the way there has been much increase in human capital that complements the structural expansion taking place.

UWMF merged with Physicians Plus Medical Group in 1998 and then expanded even further in 2003 to include University Community Clinics. Because of these mergers, UWMF has become the largest academic, multi-specialty physician group in Wisconsin and one of the 10 largest medical groups in the United States. When UWMF merged with Physicians Plus Medical Group nine years ago, it immediately added about 225 more doctors, raising UWMF membership to over 1000 faculty physicians.

Even though the merger these two organizations consumed a tremendous amount of time and energy Grossman believes that everyone is now reaping the rewards of the union.. “We clearly underestimated the cultural gaps between the two organizations,” he admitted. But “we think that having endured and persevered, we are now getting to be a truly melded organization. From my point of view, the beauty of this merger is that we really redefined a modern medical school faculty to  include respected physicians embedded in the community. This gives us true roots in the community,, provides teaching and training venues, and expands the population available for clinical and community-based research.”

What this means…

Providing community-based clinics and research provides medical students and residents with more opportunities to learn and practice medicine at UW School of Medicine and Public Health-affiliated locations. This translates into more job opportunities for aspiring physicians and a greater availability of care for patients in need of medical expertise.

“It provides us with a spectrum of care that goes from true community-based clinics to the highest level of tertiary care; an extraordinary spectrum of choice,” Grossman said. Patients have the ability to choose to be seen by UW physicians in community clinics or University Hospital clinics; they can choose to be hospitalized in close-to-home community hospitals or the University Hospital. “They have a spectrum of choice that I think is among the best in this country. They’re not constrained to a small network for their care. They’re not constrained to either an academic health center or a community setting. They really have the best of all worlds in making their health care choices.”

Affording patients these kinds of choices also means the need for new, better facilities where UW students and faculty can learn and practice. “We have had new infrastructure going up all over the place,” Grossman notes,  including the American Family Children’s Hospital, which opened its doors in August,   the Health Sciences Learning Center that has been serving students from all the health care disciplines for the last two years,, and the current construction of the state-of-the-art Interdisciplinary Research Complex that is being built just outside the University Hospital. In addition, many community clinics have been rebuilt or remodeled.

Grossman considers UWMF fortunate to be able to afford to expand UW Health in this way, and he is pleased with where they are. “We’re happy to be where we are, but we avoid any temptation for self-congratulation. There is always a huge amount of work ahead of us.”

Still facing challenges

UWMF and its UW Health partners face the same burdens and concerns felt by every other medical organization in the United States. Shifting revenue streams, rising costs, quality and safety imperatives, electronic health record implementation, and delivery of truly patient centered, accessible, and equitable care. “We are trying to meet the needs of patients, agencies, purchasers, states, and a federal government that are all frustrated by our current model of care and its inherent inefficiency, and, in some areas, ineffectiveness. While quality is often suspect, the costs of healthcare have become unbearable.”

Workforce issues also plague UWMF and the entire medical community. Grossman has particular concerns about what he calls a “crisis” in primary care. “Especially in general internal medicine, the balance between workload, physician satisfaction, and compensation has created a calculus that is drying up the stream of new physicians entering this fundamentally important field of medicine.” He thinks that the current healthcare marketplace is forcing many students and new physicians to make choices that go beyond their medical interests to the issues of lifestyle, ability to earn a living, and to escape from the indebtedness that they often take on early in their lives.  He would like to see qualitative changes in our physician workforce that reflect the need for care of an aging and chronically ill population, but thinks that this won’t be achieved until we have a payment system that truly reflects the kind of care that our society says it values. “I think we’re in for some turmoil for a while. There seems to be a “burning platform” for healthcare reform, but little light to guide the way to such reform.”

Looking ahead

While realistic about the systematic problems in healthcare organization and delivery Grossman is committed to having UW Health lead the way in improving the health of the populations it serves..  He is striving for UWMF to be an organization that “can be profoundly proud of the healthcare we’re delivering.” He is intent on building systems that more quickly, precisely, and economically translate what we “know” into what we “do”. The successful implementation of a highly functional electronic health record and a dramatic remodeling of primary care delivery are both critical intermediate term goals. Along with other leaders at UW Health, he is intrigued by, and dedicated to, the idea behind the renaming of the UW Medical School to the School of Medicine and Public Health. By creating an interface between healthcare and public health delivery, education and research, the school will try to remedy the historical discontinuity between these two areas, each of which can have a major impact on the health of our communities.

“If I have a legacy, I would like it to be more than simply the financial success for our institution, but of a clear and sustained improvement in the health of people we serve.”

-by Lindsay Robison

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