"Academic medicine has held itself up as leaders of both thinking and improvement in healthcare," he said in a telephone interview. "So the question is, if not academic medicine, then who? Where else are we going to do the research that allows us to improve the quality of care and lower its cost?"
It just hasn't happened at anywhere near the level it's needed at the places teaching the next generation of physicians, he says.
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"It's fair to say we have not seen an emphasis on care coordination as the focus of academic initiatives as much as in other areas of innovation and clinical treatment. And innovation in care management is one of the things we need desperately," he says. In fact, Dartmouth studies 15 years ago showed academic medical centers with the same readmission problems, so really nothing has changed.
Fisher also criticizes academic and community hospital systems for failing to reduce the number of beds that won't be needed when all these readmissions are avoided. Instead, hospitals are expanding lines of service with greater profit margins, even those procedures with questionable effectiveness. No money will be saved that way, he says. But more on that later.
Joanne Conroy, MD, chief healthcare officer for the Association of American Medical Colleges, acknowledged in a phone interview that the nation's teaching hospitals must do a much better job in discharge planning and managing patients in their homes or care facilities. And they need to do more research in care processes to find better ways to coordinate care and translate that into practice. They're working on it, she says.