There were lots of rolling eyes last January when, amid much civic and governmental yahooing and high-fiving, Vanderbilt Medical School and Meharry Medical College announced an alliance.
To many cynics, the deal was viewed as just another bail-out of the historically black medical school, only this time the rescuer was not the cityas it had been a few years before when the Metro General/Meharry merger was completedbut a venerable white institution still reeling from then-Mayor Phil Bredesen’s national criticism a few years before.
(Bredesen prompted a media frenzy and pushed multitudes of buttons in the Vanderbilt community when he told Sports Illustrated that Vanderbilt was the city’s “800-pound gorilla,” and that it didn’t live up to its potential as a civic citizen.)
In the eyes of the cynics, the ensuing agreement between the two schools to share research and academic programs, and the accompanying management takeover at Metro Generalwhich is housed on the Meharry campusamounted to a touchy-feely, politically correct response to: 1. a black institution’s ongoing struggle to compete for patients; and 2. Metro’s own increasing challenge in running a hospital for the indigent.
It was clear, in other words, what Meharry and Metro had to gain. But was Vanderbilt just offering charity? Was the union simply the ultimate public-relations scheme dreamed up to improve Vanderbilt’s bruised reputation?
No, says Dr. Harry Jacobson, vice chancellor for health affairs at Vanderbilt, who at the request of Meharry President Dr. John Maupin, was involved in arranging the affiliation. Jacobson insists the deal helps his medical school too, even if it was Meharry that had the most to lose if it had tried to continue without a partner.
Seven months into the arrangement, Jacobson gives the union a very good score, although he admits that neither institution has been flailing its arms about the short-term success because “we want to make sure that we don’t raise expectations inappropriately. We want to deliver something good and not promote it or over-promote it.”
Specifically, Jacobson says Vanderbilt is getting four benefits from its relationship with Meharry: access to Meharry’s family residency program, which Vanderbilt doesn’t have; access to the indigent patient population at General, which Vanderbilt lost with the merger of the city hospital with Meharry; an answer to Vanderbilt’s “relatively undiversified” student body, faculty, and staff; and a chance to better help the underserved populations in the city.
“We thought if we could team up to do that better that would ultimately decrease the drain of indigent care on our institutions,” Jacobson says. “We might as well get proactive in trying to improve the health, the access, and even the insurance coverage of the underserved in the Metro area because as we do that, number one, we do something good, and number two, we will ultimately help decrease the total expense of indigent care.”
That’s not to say Meharry didn’t need Vanderbilt more than the “800-pound gorilla” needed the struggling black school.
“Was Meharry at risk?” Jacobson asks rhetorically. “Yes, Meharry would have been at risk for accreditation. They’ve been at risk for a long time.”
While Jacobson says it’s rare for a medical school to be decertified, the school was nevertheless in danger. And had it not come calling on Vanderbilt, “they would have had to find other less suitable and less practically doable ways to meet their needs.”
Meharry’s Maupin was the brain behind the whole notion of partnering with Vanderbilt. He says he knew that existing without it would be like burying his head in the sand.
“What has been the fundamental weakness of Meharry? It’s really resources and the capitalization of the institution to compete in a world that’s far different than when Meharry was created. Meharry was created in a segregated world. Well, if you don’t get hung up on whether it’s segregated or integrated and look at it from a purely business perspective, Meharry operated in a closed market and then moved to an open market.” Any business, Maupin says, has to adjust to that.
He knew too that his school had something to offer Vanderbilt. “It’s one thing to know how to do the latest, more advanced type of surgery. It’s another thing to be familiar with the bumps and bruises that sometimes come in your office every day,” he says of the two schools’ different areas of focus.
But convincing faculty, staff, students, and alumni that it was the right thing to do was no small task, Maupin says. And neither was it for Vanderbilt’s Jacobson, who characterizes that challenge as simply something the two institutions had to “get over.”
“The only barriers between Meharry and Vanderbilt were race and history,” Maupin says. “If you could get over the cultural barrier and use the assets to your advantage, then both could advance and both of you could do more than you could by yourself.”
“Have we convinced 100 percent of them? No. I don’t think Vanderbilt has either, but there are enough people who think it’s right that we are making progress.”
The disparity between student performance at Vanderbilt and Meharry was one historical concern the Vanderbilt faculty and staff, particularly, had to get past. For example, Jacobson says, there have been past situations when a Meharry student would be on rotation with a Vanderbilt resident and performing under par.
“The student’s evaluation would come through that raised serious concerns...but nothing ever happened,” says Jacobson. “So Vanderbilt would say, you know, they’re really not interested in improving the quality of the educational experience at Meharry because they don’t take our evaluations seriously.”
Meharry, on the other hand, would say Vanderbilt’s standards are too high, Jacobson says. They’d say “our students don’t necessarily come prepared to perform at the same level as a Vanderbilt student. So they just didn’t connect before. We just had to get over that.”
Vanderbilt wasn’t the only medical institution Maupin considered as a partner. “I looked at Columbia/HCA, I looked at St. Thomas Hospital, and I looked at Vanderbilt, and Vanderbilt was the most complementary of the three. We were in the same business and we had complementary assets.”
Maupin, a Meharry dental school alumnus, says he’s tried to be “blatantly honest about the circumstances and conditions of my institution.” That meant being realistic and recognizing that not only could Meharry stand to gain by sharing assets but that health care is moving toward partnerships.
“There is, for example, some equipment that you need to have in research today,” he says. “I will never have enough volume in activity, at least within the next 5 to 10 years, to justify my having that equipment solely for myself.”
What about Metro General Hospital? Since May, when Vanderbilt brought in a management team to take over the hospital’s operations, the daily patient census there is up considerably, and the hospital is expected to operate at a slight profit this year.
“I think there’s been a substantial improvement,” says Dick Ragsdale, chairman of the hospital authority that oversees General’s operation.
Ragsdale says the hospital’s new chief executive officer, Dr. Roxane Spitzer, has closed the hospital’s deficit “by a combination of expense control and revenue growth.”
Of course, operating in the black is relative. The hospital depends upon a capped $23 million contribution from the city and a smaller amount from the state as compensation for the hospital’s indigent care.
As for the capped $23 million, Ragsdale says, “there’s no inflationary growth in that so we have to stay efficient as we grow along just to stay within the capped financial resources from Metro.”
Spitzer says the hospital remains dependent on what’s called the “disproportionate share” from the state, a subsidy that is based on the amount of TennCare, uninsured, and bad debt population the hospital serves.
Last year, that amount was $5.6 million, and while Spitzer says it’s still unclear whether Metro will get that amount againor even receive it at all as the state has been slashing the subsidyshe expects General to have a balanced budget this year and maybe even make a little money. If the subsidy doesn’t come in, it’s unlikely there will be a balanced budget.
“Our volume is higher,” she says. “Our physicians are admitting more patients and we’ve been holding expenses fairly firm. The combination has probably helped a great deal.”
It's overdue, but I'm glad it's in progress. I still don't understand, with the information…
Past time Nashville Metro, Get ya head outta ya ass and do the right thing,…
It's about time he was arrested.
TEBOW! TEBOW! TEBOW! TEBow! TEbow. Tebow....Teb....T....
@Elizzmo: What? You think a swat on the bottom of a misbehaving child is cruel?…