CLINICAL AFFAIRS COMMITTEE
Warren Gold, M.D.
Annual Report 2000-2001
The Clinical Affairs Committee (CAC) met ten times over the course of 2000-2001 academic year. The Committee focused much of its work during the year on the identification of criteria for and the preparation of an Academic Impact Report (AIR) for San Francisco General Hospital. Additionally, the Committee worked closely with the Dean of the School of Medicine and the Medical Center Administration to receive regular reports and identify ways in which the Committee could be involved in planning and budget issues related to the Medical Center operations.
Committee activities included the following:
- Completion of the San Francisco General Hospital Academic Impact Report
- Revision of Committee bylaws submitted to Committee on Rules & Jurisdiction
- Initiation of an on-going dialogue with the UCSF Medical Center Administration including regular reports on budget and planning
- Discussion of proposed changes to the UC Casual Employee Regulations
- Discussion of the proposal for a Drug Free Environment at UCSF
- Liaison with Academic Senate APB Committee to implement the new AP&B proposal on faculty involvement in budget and long-term planning.
Approval of AIR Concept (SFGH Report)
In October 2000, the Academic Senate’s Coordinating Committee approved the CAC proposal changes in existing programs and policies prior to their implementation when it is determined that such actions might have a substantial negative impact on the Academic mission of UCSF.
In August 2000, the Committee received a request to produce its first AIR regarding the financial crisis at San Francisco General Hospital (SFGH). The CAC produced a report describing the financial crisis at SFGH and the resulting impact on UCSF’s academic mission. The report, which was approved by the Senate Coordinating Committee in June 2001, is intended to help public debate by informing decision makers about the precarious state of SFGH and the enormous impact that the declining state of SFGH will have on the Academic mission of UCSF. The report, "Academic Impacts of the San Francisco General Hospital Crisis," can be viewed on the Academic Senate website. www.ucsf.edu/senate
Revision Of Committee Bylaws
In June 2001, the Committee submitted for review a revision of the CAC bylaws to the Rules & Jurisdiction Committee. The recommended bylaws would enlarge the Committee so that there would be two representatives from each school (Medicine, Nursing, Dentistry and Pharmacy). One would be a Senate member, the other would be a representative from the Clinical or Adjunct series. In addition to representing the schools, the members should also represent each of the major clinical sites (including Mt. Zion, Moffitt, VAMC, and SFGH). The Committee recommended that the bylaws be written in such a way to allow flexibility to add additional members to represent all UCSF clinical sites because representation from these locations is paramount to the work of the CAC. In addition to the Chair of the Graduate Council and the Vice Chancellor for Medical Affairs as ex-officio members, the Committee has also requested that the CEOs from Moffit-Long, VAMC and SFGH be added as ex officio members of the Committee. The CEOs will not be expected to attend every meeting, but will meet with the Committee only when their attendance is felt to be useful and important.
Dialogue with Medical Center Administration on Budget and Planning Issues
The Committee on Academic Budget & Planning (APB) forwarded a proposal to the CAC that included an expanded faculty involvement in the UCSF budget and long range planning process. CAC has, and will continue to coordinate with the Senate’s APB Committee regarding long range planning and budget processes related to the UCSF Medical Center.
CAC has already initiated an on-going dialogue with Mark Laret, CEO of the UCSF Medical Center. Mr. Laret supports faculty involvement in the planning and budget process as long as the Committee does not seek to micromanage the process. Consequently, select Committee members are participating in a tutorial about the UCSF Medical Center budget process. Mr. Laret also began reporting to the Committee on issues facing the Medical Center. Mr. Laret expressed concerns with problems related to recruiting and retaining medical staff, overcrowding in the Emergency Department, and the significant financial strain caused by MediCal payments which do not cover total costs.
In March 2001, Mr. Laret introduced the Medical Center’s new Chief Financial Officer (CFO), Ken Jones to the Committee. Mr. Jones distributed the Medical Center’s financial update report and reviewed the data with Committee. Budget Projections for the UCSF Medical Center for the fiscal year were summarized as:
- Estimated to lose $25 million in fiscal year 00-01
- Estimated to lose less than $25 million in fiscal year 01-02
- Money is expected to be saved by cutting costs at the periphery of the operation without affecting bedside care, while at the same time increasing efficiency
- Increase revenues expected
Mr. Laret has indicated to the Committee that he remains concerned that costs related to supplies (pharmaceutical) and labor have increased substantially for the Medical Center, while revenues have not kept up with expenses due to inadequate Medicare reimbursements, and the need to improve the UCSF billing system. Additional revenue is anticipated with the continued improvement of internal management of the Medical Center. It is expected that these improvements will result specifically from continued evaluation of cost-effective procedures, use of standardized products, improvement of systems and reduction of unnecessary work and the possibility that MediCal rates may increase.
The Medical Center made a major investment in a computer-based physician order entry system called "Last Word." The CAC members requested that faculty, responsible for patient care, participate in the earliest stages of discussions regarding implementation of this system. This request was made in order to avoid problems encountered by other University Medical Centers who have implemented "Last Word" without simultaneously seeking faculty input.
Mr. Jones will be attending meetings of the Clinical Affairs Committee on a quarterly basis in order to provide the Committee with updated information on the Medical Center’s budget.
Issues for the 2001-02 Academic Year
Issues for the 2001-02 Academic Year
Suggested new or continuing topics for next year:
Continue liaison role on APB Committee and identify how CAC will coordinate with APB on matters related to the Medical Center planning and budget process
Continue to monitor status of changes at SFGH
Committee on Clinical Affairs
Warren Gold, Chair
Susan Janson, Vice Chair
Raymond Braham, Clinical/Adjunct Representative
B. Joseph Guglielmo
Hope S. Rugo, Clinical/Adjunct Representative
Haile Debas, Vice Chancellor, Medical Affairs, ex officio
Jane Weintraub, Chair, Graduate Council, ex officio
July 20, 2001
CAC Annual Report 00-01.doc