"任务调整资金流":对临床科室的影响。

IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES
Satyan Lakshminrusimha, Susan Murin, Joseph Galante, Zishan Mustafa, Noel Sousa, Stanley Chen, Debbie A Aizenberg, Elizabeth Morris, David A Lubarsky
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引用次数: 0

摘要

问题:学术医疗中心面临着医疗成本高、报销额度减少、竞争激烈、利润率低等问题。许多因素,包括高比例的公共保险患者、奖励程序性专科的模式以及研究和教育支持负担,导致了教职员工薪酬不平等、医生离职和招聘困难:方法:加州大学戴维斯分校医疗中心于 2021 年 7 月实施了资金流调整模式,以创建一个与使命相一致的模式,在该模式下,所有部门都有财务利润空间,以优化招聘、留任、研究和教学:加州大学戴维斯分校医疗中心采用这种模式的 3 年经验(2021-2024 学年)的特点是医生薪酬、医生招聘和利润增加。各部门的总收入在资金流的第一年增加了 4%,第二年增加了 0.2%,第三年增加了 11.3%。总生产率在第一年增加了 4.9%,第二年增加了 3.6%,第三年增加了 8.4%。第 3 年,所有部门类别的工资都有所增加。每位教职员工的生产率和收入在第一年有所增长,第二年和第三年保持稳定。由于科室收入不受支付方组合的影响,而且医院协议更加公式化,因此手术、初级保健和医院服务项目之间的均等性得到了改善。医院对资金流的贡献从 2022 年的 6700 万美元增至 2024 年的 1.01 亿美元:定期沟通和透明度对于持续信任和成功实施持续资金流至关重要。新模式改善了医生薪酬,增加了招聘。然而,资金流的实施对学术医疗中心的财政产生了负面影响,可持续性可能需要微调,以平衡承受能力。作者计划将门诊初级保健转变为基于生产力的模式,并将对新教师的有时限支持从 2 年减少到 1 年。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
"Mission-Aligned Funds Flow": Effect on Clinical Departments.

Problem: Academic medical centers struggle with the high cost of care, reduced reimbursement, intense competition, and low profit margins. Many factors, including a high proportion of publicly insured patients, a model rewarding procedural specialties, and research and educational support burden, led to faculty salary inequities, physician disengagement, and difficulty recruiting.

Approach: UC Davis Health implemented an aligned funds flow model in July 2021 to create a mission-aligned model in which all departments had financial margins to optimize recruitment, retention, research, and teaching.

Outcomes: The 3-year experience (academic years 2021-2024) with this model at UC Davis Health was characterized by physician compensation, physician recruitment, and profit increases. Total collections for departments increased by 4% in the first year, 0.2% in the second year, and 11.3% in the third year of funds flow. Total productivity increased by 4.9% during the first year, 3.6% during the second year, and 8.4% during the third year. Salaries increased in all departmental categories in year 3. Productivity and collections per faculty member increased during the first year and were stable during the second and third years. Parity among procedural, primary care, and hospital-based service lines was improved because departmental revenue was agnostic to payer mix and hospital agreements were more formulaic. The hospital contribution to funds flow increased from $67 million in 2022 to $101 million in 2024.

Next steps: Regular communication and transparency are critical to ongoing trust and success with implementation of sustaining funds flow. The new model resulted in improved physician compensation and increased hiring. However, the implementation of funds flow had a negative fiscal effect on the academic medical center, and sustainability may require fine-tuning to balance affordability. The authors plan to convert outpatient primary care to productivity-based models and decrease time-limited support for new faculty from 2 years to 1 year.

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来源期刊
Academic Medicine
Academic Medicine 医学-卫生保健
CiteScore
7.80
自引率
9.50%
发文量
982
审稿时长
3-6 weeks
期刊介绍: Academic Medicine, the official peer-reviewed journal of the Association of American Medical Colleges, acts as an international forum for exchanging ideas, information, and strategies to address the significant challenges in academic medicine. The journal covers areas such as research, education, clinical care, community collaboration, and leadership, with a commitment to serving the public interest.
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