Most of our centers continue to have strong programs of education, research, and patient care, and increasingly in technology transfer and in public health and patient education. Much of the credit for the continuing solvency of many of our institutions must go to our hospital CEOs, who have figured out how to stay substantially in the black in the face of significant cost pressures. Yet we all continue to feel the pressure to reduce costs and to become ever more competitive with the private players in clinical care and increasingly in many areas of research. Overwhelmingly, we remain vulnerable to even the slightest changes in reimbursement, patient demographics, payer reimbursement schedules, new competitors in specialized fields, and the ebbs and flows of support from NIH, NSF, and the philanthropic sector. In other words, we remain subject to the impact of external forces that continue to shift and change and create new challenges.
Few centers are really master of their own destiny.
On the clinical side, we will see more of the same pressures to lower costs and for reduced payments. Cross-subsidizing research and education will become even tougher. This means, first of all, that we need to be hard-nosed and require careful budgeting in all units. I know this sort of attention to budgeting is not a popular idea, but I can't emphasize enough how important it is. We must know how our costs are generated and where our revenues and our service costs and our productivity issues are.