In an environment of capitation and prospective payments, such adverse selection may be detrimental to the survival of the academic medical center. Academic medical centers have often focused on care of the underinsured and fragile population, constituents of our society who are by and large ignored by the current forces of managed care and other payers. Current and proposed payment policies of the Health Care Financing Administration fail to recognize the unique role of academic medical centers in the delivery of health care services to Medicare beneficiaries and threaten the financial viability of institutions and programs that serve a critical public good. Each academic cardiovascular program has a critical and minimal patient volume that is central to its missions, but cannot resort to historical strategies to maintain patient referrals fundamental to its teaching and research missions. Traditional organizational schemes of academic departments have placed cardiovascular programs with less related specialties, rather than with specialties such as cardiovascular surgery, interventional radiology, cardiovascular anesthesia and pediatric cardiology.
Several factors render traditionally structured academic centers ineffective in the marketplace.
The business of academic cardiovascular programs has historically relied on delivering high quality services and a monopoly in tertiary care of complex patients. However, they have succeeded in training outstanding physicians who have moved into the community. As high quality cardiovascular resources have proliferated in the community, academic cardiovascular programs have lost much of this traditional advantage to the community provider. Separation from the community. Traditional academic cardiovascular programs have segregated themselves from their primary care feeder stream to pursue their tertiary and quaternary care goals and have had difficulty constructing the provider networks that are necessary to contract under managed care.