May 21, 1998

University Medical Associates, which includes the physician practice plan for MUSC, is from time to time the subject of media attention. At times, UMA’s governance or purpose, or the way it compensates clinical faculty is called into question. Marion Woodbury, chief executive officer of University Medical Associates, attended the May 19 communications meeting to give the management team information on how and why UMA was formed and how the organization is governed. He also explained established guidelines for clinical faculty compensation. A summary of his presentation is included in this Currents. Many public academic health centers throughout the nation have organizational entities similar to UMA. The UMA plays a vital role in enabling MUSC to fulfill its mission.

W. Stuart Smith Interim Vice President for Clinical Operations Interim CEO, MUSC Medical Center

Recognition

• Carol Dobos, director of Children’s Services, recognized a number of people who participated in a May 17 poster session on parent and child research, sponsored by the College of Nursing and MUSC Children’s Hospital. The faculty and staff presenting posters were: Yvette Alger, Harriet Allen, Linda Bellig, Robin Bissinger, Sandra Brown, Carol Dobos, Evelyn Duncan, Amy Ethridge, Mary Hughes, Merrilyn Johnson, Nathan Johnson, Allen Jones, Marilyn Laken, Lisa Langdale, Marie Lobo, Francine Margolius, Elaine Matters, Tara McComb, Melodie Olson, Karen Rankine, Jean Rhodes, Kathleen Simon, Jean Smith and Pat Wagstaff. She said she was glad all participated in this wonderful event.
• Carol Dobos also recognized Lynn Hadley, Sue Santangelo, Alison Turner and Deborah West, who worked together on a book that has been accepted for publication. The book is entitled, Developmental and Behavioral Characteristics of Preterm Infants.
• Pam Cipriano, Ph.D., administrator of Clinical Services, announced that Carol Dobos also had a chapter accepted for publication in the book, Managing Health Care Resources—Present and Future Challenges. The chapter is entitled, “The Impact of Shared Governance on Resource Management.”

Announcements

AT&T Language Line Access

• Carol McDougall, coordinator of Clinical and Patient Education, recently reported that AT&T language line access for 140 languages will be soon be available for the Main Hospital, MUSC Institute of Psychiatry and University Medical Associates. This service will be available June 1 to support non-English speaking patients or family members and may be used for: outbound calls to a foreign country or a non-English speaking person to give or get information; inbound calls from a non-English speaking person; and for on-site interpretation of non-English speaking patients or family members.

• The service will be available during normal working hours (8:30 a.m. to 5 p.m.) by contacting the social worker for the respective area. After normal working hours, the Hospital Services Coordinator should be called. The hospital operators have the AT&T language line number and will be responsible for the connection. A single-line speaker phone is needed to facilitate calls and can be borrowed from the hospital operator (room 243 North Tower) prior to placing the call.
• The following information will need to be provided when requesting language service: the language needed, the patient’s medical record number and name of the person requesting the service.
• A brief training videotape is available from McDougall at 792-9779 or Peggy Duffy, Ed.D., R.N., of Clinical and Patient Education at 792-5078.

The History of UMA, MUSC’s Faculty Practice

• Marion Woodbury, chief executive officer of University Medical Associates, gave the management team an overview of UMA’s history and governance, and explained the various state laws and governance structure for oversight of clinical practice compensation.
• In 1964, the Professional Staff Office was organized as a partnership to systemize billing and collections for physician services.
• In 1976, the State Commission on Higher Education endorsed guidelines for medical practice plans in South Carolina. These guidelines outlined how clinical faculty members could earn “salary supplementation” for professional fees above their state “base salary.” Another enabling act for setting physician earnings came at about the same time with the passage of Section 72 of the S.C. Code of Laws. This included the provision that funds from approved private practice plans of state institutions may be expended by the respective institution’s board of trustees. For MUSC, that meant the MUSC Board of Trustees could set rules for how the funds generated by the clinical practice (at that time the PSO) could be spent.
• Once state-employed faculty members earn tenure, they are entitled to a set base salary but not their salary supplementation earned through the clinical practice plan.
• In 1991, UMA was formed under the oversight of MUSC to replace the PSO. The UMA was established as a not-for-profit corporation with the Internal Revenue Service designation of 501(c)(3). In a survey of the legal structure of other faculty practice plans around the country, both for private and public hospitals, UMA found that almost half are part of the infrastructure of the university organization. This is common among private institutions. About half are not-for-profit corporations like UMA, and a few are for-profit.
• The purposes of UMA, expressed in its bylaws and articles of incorporation, are:
• To promote and support the educational, medical, scientific and research purposes of MUSC.
• To deliver inpatient and outpatient professional services for the benefit of MUSC.
• To promote superior patient care at all sites within the academic and research environment of MUSC.
• To promote the recruitment and retention of superior faculty.
• To engage in charitable programs related to patient care, education and the research mission of MUSC.
• To provide the full-time clinical faculty of MUSC and other health professionals with the development of group practice of medicine and related services in furtherance of medicine and medical research.
• To promote, encourage and aid investigation and research by the faculty, staff and students of MUSC.
• The MUSC Board of Trustees possesses a number of mechanisms of control over UMA such as:
• The MUSC Board of Trustees approves UMA bylaws and any changes to those bylaws.
• Two members of the MUSC Board of Trustees sit on UMA Board.
• Four vice presidents of MUSC serve on the board of UMA.
• The two community representatives on the UMA board are named by the MUSC president.
• ll UMA members must be MUSC faculty members who are approved by the board.
• The UMA board chairman and the UMA CEO report to the vice president for medical affairs and dean of the College of Medicine.
• UMA is excluded from owning property except as specifically approved by the MUSC Board of Trustees.
• All faculty salaries including UMA portions are approved by the vice president for medical affairs and dean of the College of Medicine and the president.
• The UMA Board of Directors has 33 members, including four officers elected by the faculty of UMA, MUSC’s vice president for academic affairs and provost, MUSC’s vice president of finance and administration, MUSC’s vice president for medical affairs and dean of the College of Medicine, MUSC’s vice president for clinical operations and CEO of the Medical Center, the chairs of the 17 clinical departments, two representatives from the MUSC Board of Trustees, two members from the community and five people elected from the UMA membership.
• State law stipulates that the maximum salaries of UMA faculty shall be approved in advance by the MUSC president or Board of Trustees. Also, all employees (not only physicians) must report any additional compensation (excluding travel reimbursement) received to the Division of Budgets and Analyses of the State Budget and Control Board.
• Last year, UMA had cash receipts of $135 million dollars. Of that, 31 percent was earmarked for faculty compensation, seven percent was transferred to MUSC, a little over 13.6 percent supported activities of the departments of the College of Medicine, 20 percent was spent for operation of the ambulatory care clinics and 15 percent went to cover UMA overhead. About 10 percent was retained and carried over.
• Woodbury also illustrated the breakdown of funding without the ambulatory care numbers included. Of the $97 million of professional fees generated, approximately 44 percent went to faculty members, 5 percent was transferred to MUSC, 19 percent went to support the academic departments, 15 percent went to overhead and 13 percent was retained as carryover.
• The affiliated organizations of UMA include: Carolina Family Care, the network of primary care physician offices established in 1994; Carolina Health Management Services, which employs the management staff of Carolina Family Care; and Carolina Specialty Care, a new organization established to organize the specialty care provided by UMA faculty out in the community.