September 17, 1998

We were greatly saddened that Darryl Huneycutt, manager of clinical support systems, passed away on September 16. He was an outstanding family man and citizen and a highly respected member of our management team.

Mr. Huneycutt was known for his commitment to excellence in customer service and innovation. Among other things, he led the development of the Medical Center’s Statlan system which we heavily rely upon today. He spearheaded efforts resulting in our modern networking.

The Medical Center greatly benefitted from Mr. Huneycutt’s talents during the past ten years. He touched the lives of many of us and we will remember him fondly.

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

Announcements

• A teleconference on Medicare Fraud and Abuse will be held Wednesday, Sept. 23, from 2 - 4 p.m. in the 2 West Amphitheater and in Room 100 Basic Sciences Building. Contact Reece Smith via E-mail at smithre@musc.edu to reserve a space. Call her at 792-6128 with any questions.

The Budget Balancing Act

• Stuart Smith spoke to the management team on the Balanced Budget Act of 1997 and its effect on the financial health of MUSC. He called the act the most significant piece of legislation to impact health care since the creation of the Medicare and Medicaid programs in the 1960s.

• A Deloitte & Touche study of the Balanced Budget Act estimates that $115 billion will be cut from Medicare by 2002. In fiscal year 1998, MUSC saw a cut of $4.7 million, and in fiscal year 1999 expects a cut of $6.8 million. This amounts to only 20 percent of the total expected impact of federal cuts from the act.
• Medicaid funding cuts also are expected to increase. In fiscal year 1998, MUSC saw a $1.5 million cut, and expects a $2.9 million cut in fiscal year 1999 and a $9.3 million cut in fiscal year 2000.
• Smith said the Medical Center is taking action to offset the impact of these cuts.
• The budget process is now more detailed and Hospital Administration is committed to providing more information and reviews for those responsible for budgets.
• Compiling benchmark information on clinical functions has been comprehensive, but less so for administrative areas. Hospital administration will focus upon benchmarking information for administrative functions.
• During the years, the Medical Center has made a practice of transferring funds in the form of non-mandatory transfers to the university. These transfers will no longer be automatic. (Smith also noted that the reality of tighter finances is not limited to the Medical Center. The university and University Medical Associates also are looking closely at costs.)
• Facilities planning will continue to increase in importance. Because of the growth of the Medical Center in recent years, it has outgrown its capacity. Smith said the highest priority for facilities planning is to find ways to increase the number of medical-surgical beds available so the opportunity for continued growth is not lost.
• Measurement and accountability are a high priority for Hospital Administration. “If you can’t measure it, you can’t manage it,” as the business maxim goes. Smith said the Medical Center needs to emulate private business in finding the best ways to measure our performance so that we can improve upon it.
• The State Budget and Control Board has commissioned the accounting and consulting firm of KPMG Peat Marwick to look at MUSC and make a recommendation on what its role should be in the state system. KPMG will give a report to the MUSC Board of Trustees at its next retreat. Smith said in looking at MUSC and comparing it to similar facilities, KPMG seems to be confirming what Hospital Administration has known for some time. The firm’s “lessons learned from other state academic medical centers” include the following “driving factors” behind restructuring:
• The constraints of state personnel systems.
• The need for more flexibility in purchasing.
• The limits placed on joint venturing.
• The lack of access to capital. (For example, it is difficult for MUSC to accumulate cash, making it hard to save for large projects.) q The inability to compete in the marketplace.
• The burdens of bureaucracy and delays. q Deficits or projected deficits and financial instability. (Smith said MUSC is at an advantage here, as it is not in financial difficulty. Many facilities wait to restructure until they are in financial trouble, making the process more difficult.)

Telemedicine Project Under Way

• Patrick McShane, director of program development in Hollings Cancer Center, spoke to the management team about a telemedicine project currently under way in Hollings Cancer Center and the Department of Urology. One of the applications of the telemedicine system will include the medical procedure of an ultrasound-guided prostate biopsy.

• McShane said this project is one piece of a larger initiative funded by a Department of Defense grant. The Coastal Cancer Control Program, begun in 1996, includes several projects to reach underserved populations in the coastal communities of South Carolina. Daniel Nixon, M.D., professor of medicine in the Division of Hematology/Oncology, is the principal investigator of MUSC’s research in this program.
• The goal of the telemedicine project is to bring health care services to underserved areas more efficiently. Thomas Kirkland, M.D., professor of urology, will be working with a nurse practitioner in Port Royal, guiding him through the prostate biopsy procedure via Netscape on the Internet. q MUSC’s partners in the project are GEO-Centers Inc. and IBM. Assistance was given early in the project by the United States Army’s Telemedicine Advanced Technology Research Center, or TATRC, a triservice-funded center at the hub of advanced telemedicine programs, and Walter Reed Medical Center, one of TATRC’s test sites.
• Because hospitals cannot yet bill for telemedicine services, most of the focus of this work has been in research. However, McShane expects that billing for such services will be accepted in two to three years.
• Information on patients participating in the project will be connected to patient records so that it can be accessed should the patient ever receive treatment at MUSC.
• Phase I of the project encompasses the Department of Urology’s work with the Port Royal facility and also a connection to Walter Reed’s prostate research, prevention and control data. Phase II expands the project to the VA Medical Center and to other sites, including those in the Georgetown and Grand Strand regions. Procedures will expand to include endoscopy, surgical mentoring and oncology procedures.
• Other projects on campus that involve telemedicine include work in the Digestive Disease Center with international teleconferencing, a project under way in the Department of Family Medicine, and teleradiology work involving the Department of Radiology and Hampton Hospital.