Leaders from North Carolina's top medical schools were in Washington Wednesday, speaking to congressional members about the effects of impending federal budget cuts on the nation's standard of health care.
Dr. Ralph Snyderman, chancellor of health affairs at Duke and dean of the school of medicine, led a delegation that included medical school deans from the University of North Carolina at Chapel Hill, Wake Forest and East Carolina University.
The deans had lunch with House representatives from North Carolina and met with N.C. Sens. Jesse Helms and Lauch Faircloth. Snyderman said that the legislators were very receptive to the delegation's arguments for continued federal support.
"We had a very good dialogue as to how they could help pass legislation to protect the infrastructure of academic health care," Snyderman said.
As congressional leaders strive to pare roughly $350 billion from the federal budget over the next seven years, some have proposed cutting about $4 billion in Medicare funding.
Medicare funds support virtually all graduate medical education and care for the poor, the very ill, and those with rare diseases -- responsibilities largely borne by academic medical centers, such as Duke. Cutting such aid could have disastrous effects on the nation's academic medical centers, and in turn, the nation's quality of care, Snyderman said.
"Virtually all health care providers... are trained in one way or another in academic medical centers," he said. "All improvements in health care have [at some point] worked their way through academic medical centers. As academic medical centers, we take care of the majority of the indigent, of the very ill, and of [those with] rare [and] chronic diseases."
With the advent of managed care and insurers' clamping down on health care costs, academic medical centers are feeling more than a pinch.
"We are now facing market forces like never before, valuing medicine by what it costs," Snyderman said.
Collaborating with Faircloth, Duke will lead the effort to recommend a number of viable alternatives in the next several weeks to control health care spending without cutting "the muscle and skeleton of the American health care system," Snyderman said.
Faircloth expressed interest in proposing legislation based on the recommendations made by Duke and the other medical schools, Snyderman said.
Snyderman's visit to the nation's capitol follows on the heels of a trip Dr. Mark Rogers, CEO and executive director of Duke Hospital, made to the White House two weeks ago. Rogers was invited by Vice President Gore to discuss the implications of balancing the budget on the health care industry.
Rogers said that reduced federal support would directly affect hospitals, physicians and the size of residency programs. "It is possible that we [Duke Hospital] might lose as much as 5 to 10 percent in total revenue," he said.
In anticipation of severe cuts, Rogers said that Duke could limit the size of its residency programs over the next several years.
Snyderman said that academic medical centers would be disproportionately affected by the proposed cuts. "We could never compete head to head with [for-profit health care groups] because of our commitments to education and research. My feeling is that these are societal goods."
The emergence of managed care provides an important role for centers like Duke, Snyderman said.
"Any hopes for having true cost-effective treatment will have to come from clinical research at academic medical centers."
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