Penn State chief sees threat in health care, pension costs

STATE COLLEGE, Pa. - Rising health-care costs and a looming state pension-funding crisis threaten to add more financial uncertainty to Pennsylvania State University's already tight budget, university president Graham Spanier says.

The school on Friday received a portion of $334 million in state subsidies and federal stimulus funding that had been held up for months by legislative gridlock in Harrisburg. But appropriations have been shrinking, and the university isn't sure what will happen when stimulus money dries up.

The financial future has been made more complicated by long-term concerns about health care and the State Employees Retirement System.

That pension system is expected to require massive infusions of cash in coming years, and Penn State could be forced to find tens of millions of dollars annually to make up for shortfalls.

Throw in uncertainty about the economic recovery and this year's race for governor, and Spanier's outlook for the future gets more cloudy.

"Right now, I would have to say we have our highest level of uncertainty in doing long-range planning than we've ever had in my 15 years as president of Penn State," Spanier said during a break in a meeting of university trustees Friday.

He did confirm that Penn State would not need to raise tuition at midyear to make up for current budget pressures. As he spoke about financial issues, he was informed that the school had just received about $150 million in state funding, a lump sum of roughly six months' worth of funding held up in the legislature. The rest is to be paid in monthly installments.

That funding primarily helps in-state residents pay lower tuition than out-of-state residents. For instance, a full-time, in-state freshman or sophomore at Penn State's main University Park campus pays $6,800 a semester, while an out-of-state freshman or sophomore pays more than $12,500.

"If we didn't have that, in essence what we would be doing is turning all students into out-of-state students," Spanier said.

Penn State has an enrollment of more than 94,300 at its 24 campuses and online, including roughly 44,800 at University Park.

The university is considered a "state-related" institution, with 8 percent of its income coming from state funding. Appropriations have gradually become a smaller source of revenue, declining 1 percentage point each year, Spanier said.

Tuition dollars are the biggest revenue source, about 34 percent, followed by hospital and medical-services revenue and research grants. Applications for enrollment continue to increase, and Spanier said the other areas "are in pretty good shape right now."

Private donations are also expected to pass state funding as a revenue source soon, he said. The school received more than $58 million in donations in December, a one-month record for the university.

Spanier is scheduled to appear before the legislature in the coming months to talk about the school's budget requests, which ask for a 3.9 percent increase in funding to $360.9 million.

The school projects that receiving that amount would limit tuition increases to between 3 and 5 percent.

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Meet NEPA's Future MDs on the Next State of Pennsylvania on WVIA

PITTSTON, PA (WVIA) - The Commonwealth Medical College in Scranton, Pennsylvania is in session, but who are the students? "Meet NEPA's Future MDs" on the next State of Pennsylvania, this Thursday, Jan. 28 at 7 p.m. on WVIA-TV.

Who's saying the Commonwealth Medical College in Scranton will transform our region? How is the college teaching young Pennsylvanians to be future doctors? What's different about their education that will make them better MDs? What drew them to Scranton for medical school?

These and many more questions will be answered when WVIA President Bill Kelly welcomes Robert M. D'Alessandri, MD, President and Dean of the Commonwealth Medical College along with medical students Charles Karcutskie from West Wyoming, PA, Sara Roper from Beaver, PA and John Kotula from Moscow, PA to the show.

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High school teen struck by middle school principal in SUV

A high school student was struck and injured by a sport utility vehicle (SUV) driven by a North Middle School principle on Monday morning, January 4, 2010, according to the Philadelphia Inquirer.
Police and emergency medical services (EMS) responded to the incident. Police reported that the 15-year-old sophomore was crossing the street from Pennbridge High School at 6:45 a.m., when he was struck by an SUV driven by the Principle of North Middle School identified as Margaret Kantes.
EMS transported the injured Bucks County teenager via helicopter to Lehigh Valley Medical Center. He was treated by doctors and nurses for a potential traumatic brain injury (TBI) and was listed in critical condition. Kantes rolled to a halt at the 5th Street and Campus Drive after the tragic incident.
Kantes immediately called the police. She reported that the boy had been wearing a dark hoodie at the time of the crash. She said she did not see him. There have not been any charges brought against her as of yet. Police continue to investigate the crash. Officials impounded the SUV as part of the investigation. Prior reports showed that another driver, or a school bus had struck the teen.


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Medical students reckless on Internet, sometimes at patients’ expense

In 2007, a resident surgeon snapped a picture of a patient’s tattoo—the words Hot Rod on his penis—and shared it with colleagues, making international news when the story was leaked to the press. At least the resident didn’t post the picture on the Internet.

A new survey suggests that with the rise of blogging and sites like Facebook, Twitter, and YouTube, such a thing could happen. In fact, 60 percent of medical schools have had students post inappropriate or unprofessional information on the Web, according to a study in the September 23/30 issue of the Journal of the American Medical Association.

Most of the time, the information was related to the student’s own behavior, including drunken, drug-related, or sexually suggestive images or comments, as well as the use of profanity or discriminatory language.

But six schools, or 13 percent, reported incidents in the past year that involved content that violated patient privacy. For example, some students blogged about their experiences with enough detail to identify patients, and one student posted patient details on Facebook. Most of the time other trainees told the dean about the indiscretions, but in two cases, patients or their families blew the whistle.

“We expected to find incidents of unprofessionalism, but the number was higher than expected,“ says lead study author Dr. Katherine C. Chretien, of the Washington, D.C., VA Medical Center.

Less than half of schools currently have policies in place to police or punish such behavior.

In the study, the researchers sent out anonymous surveys to medical school deans or their representatives at each institution in the Association of American Medical Colleges (AAMC)—a total of 130 schools. Of the 78 schools that responded, 47 reported ever having an incident. In the previous year, 13 percent of those schools reported no incidents, 78 percent had fewer than 5 incidents, 7 percent reported 5 to 15 incidents, and 2 percent had some incidents but did not know exactly how many.

Of those that reported an incident and responded to the question about disciplinary actions, 30 gave informal warnings and three students were expelled. Overall, 38 percent of the schools had policies in place that cover unprofessional online behavior and 11 percent of the schools without such policies were working on developing one.

Deans who reported incidents were more likely to have such a policy in place, the survey found.

“This is a pretty new issue for medicine,“ Chretien says. “We need to have a discussion about what kind of information is appropriate to be out there and what defines medical professionalism in the online world.“

Other professions are also grappling with the same types of issues, she says. “The difference with medicine is that we have patients’ privacy to maintain, and that is critical; doctors have also been held to a higher moral standard, at least historically.

“There needs to be better education in medical schools about protecting patient privacy on the Internet because even if [students] don’t use direct patient identifiers, you can still identify someone with certain characteristics,“ she says.

Arthur Caplan, the director of the University of Pennsylvania Center for Bioethics, says he was surprised that more institutions had not begun to adopt policies about the Internet. “Today’s medical students think of the online world as freewheeling and open-ended with no rules, and we have to educate them that they can’t take that attitude when discussing their patients or personal information,“ he says.

Medical students may be accustomed to being free with their thoughts and photos on the Web, but the Internet is not a free-fly zone for future doctors. The only way to reign in this behavior is to punish violators, Caplan says. “First-time violators should get suspended, which is serious stuff, and second-time violators are out,“ he explains. “We also need to remind and teach students what medical privacy is in terms of the Internet.“

Dr. Jordan Cohen, a professor of medicine at George Washington University and a former president of the AAMC, says he finds the study results not all that surprising, given the popularity of social-networking sites.

“It’s clearly an area that should be addressed by schools,“ he says. “The Internet needs to be included in examples of potential areas where unprofessional behavior can occur.“


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Dispatch from the medical front

Like many other would-be physicians, my journey into medicine started full of energy and hope.  In the face of a very public doctor shortage, I thought surely Canada would do everything to retain its best and brightest. Applying to Canadian medical schools quickly changed my opinions on this.

Ontario is one of, if not the most difficult place to get into medical school in North America; entry is especially difficult if you are from the greater Toronto area.

I cannot tell you how many of my colleagues with near perfect grades, extensive community involvement and great Medical College Admission Test scores, were unable to get in.

The lucky few get in somewhere in Canada or the United States, like myself, now enrolled in Jefferson Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania. The rest end up mainly at schools in the Caribbean, Australia, or Ireland. Or turn away from medicine.

Why is that?

The first thing that jumps into my mind is the acceptance format for the universities of Toronto and McMaster, the two schools in greater Toronto area. Neither gives preference to students from the area. Yet, most other schools have set aside spaces and favour applicants from their own geographic region. For example, the University of Ottawa, Northern Ontario School of Medicine, and the University of Western Ontario all treat “local” applicants preferentially.

It seems unfair that someone who grew up 2-3 hours down the 401 can get an interview with lower grades and MCAT scores. We are all from Ontario and should be treated as equals, shouldn’t we?

As well, applying to out-of-province schools is even more problematic, as few spaces are available for us “foreign” applicants.

I am sensitive to the needs of underserved communities for whom these regional acceptance practices were created. The purpose of extending preferential recruitment to local applicants is, of course, to encourage doctors to stay and practice in the area.

However, the end result remains: many qualified, motivated, enthusiastic and otherwise-deserving students are being turned away from medical schools simply because of where they live.

What is the answer?

It seems logical that another medical school should be built in the greater Toronto area and and that more spaces for out-of-province students should be created across the country.

Our current admission policies are losing students with a passion, drive, and commitment to medicine - not because they are unqualified, but because we haven’t created space for them. We are losing some of our best students to schools in other countries, which is an admission that no Canadian should prefer.

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Medical examiner IDs man in Pa. standoff suicide

PITTSBURGH - The Allegheny County Medical Examiner's Office has identified a man who police believe shot himself to end a standoff in the Pittsburgh suburb of Mount Lebanon.

Police say officers were trying to serve a protection from abuse order on 51-year-old Ronald Giron Wednesday afternoon. Police say a standoff resulted because Giron had a gun, so officers backed off and requested backup. Police attempted to negotiate with the man but he broke off contact at around 6:15 p.m.

When police entered his home, they found him dead.


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Mayo's prowess indisputable, but can it be replicated

ROCHESTER -- The Mayo Clinic looms out of the prairie here like the mecca it has become, a world-renowned medical complex that is often cited by President Obama as his model for national heath-care reform.

"Look at what the Mayo Clinic is able to do. It's got the best quality and the lowest cost of just about any system in the country," Obama said in Minneapolis this month. "So what we want to do is we want to help the whole country learn from what Mayo is doing. ... That will save everybody money."

Few dispute the prowess of Mayo, which brings in $9 billion in revenue a year and hosts 250 surgeries a day. But a battle is under way among health-care experts and lawmakers over whether its success can be so easily replicated. Before embracing a fundamentally new approach to health care, dissenting experts and lawmakers say, Congress should scrutinize the assumption that a Mayo-type model is the answer.

They point out that Mayo's patients are wealthier, healthier and less racially diverse than those elsewhere in the country. It has few poor patients. It limits the number of procedures it performs per patient, but the rates it charges private insurers and self-paying patients is higher than average, allowing it to thrive despite the lower Medicare spending cited by its supporters.

Armed with their new stature, officials from Mayo and a handful of similar facilities have become determined lobbyists in their own right. They are pushing for an overhaul of Medicare that would reward cost-effective hospitals and doctors, while punishing others.

But if the Mayo model is, in fact, difficult for even the most dutiful hospitals elsewhere to mimic, such an overhaul could set up many providers nationwide for failure -- and a big loss of funds.

"It's not (Mayo's) model. It's their patients and money. If you have the money, you can attract good staff, good doctors, good nurses," said Richard A. Cooper, a professor of medicine at the University of Pennsylvania. "You are going to force hospitals to find ways to avoid taking care of poor people just because they are going to be penalized because poor people cost more."

Mayo and other oft-cited model facilities also are lobbying against one of Obama's favored provisions: a government-run insurance plan, or public option, which would work against these hospitals' financial position.

"What they want to do is leverage their high-quality delivery systems to keep as much of a private delivery system as possible," said Gerry Shea, the AFL-CIO's chief health-care negotiator.

Mayo and the other model centers -- which tend to be in the Upper Midwest, Mountain West and Pacific Northwest -- have gained their current stature because of Dartmouth University research showing that they spend less per Medicare patient than their counterparts elsewhere, including in Miami, Los Angeles, New York and much of Texas and the South. Many experts have seized on the data to conclude that the key to reining in health-care spending is to emulate Mayo -- a large group practice in which physicians are on salary and have less incentive to perform unnecessary procedures than physicians paid on a "fee for service" basis.

"These communities are able to control utilization [of health care] without harming patients," said Don Berwick, head of the Institute for Healthcare Improvement.

Mayo officials say their model dates to the clinic's founding in the late 19th century by brothers Charles and William Mayo, still known around the campus simply as "Charlie and Will." As their clinic grew, it became known for its quality and the brothers' insistence that doctors work on salary.

That, Mayo physicians said, has drawn doctors more committed to their professional obligations than to making high salaries by racking up procedures. "I didn't go to medical school to be the hardest-working guy in the room. I went to medical school to take care of patients," said cardiac surgeon Thoralf Sundt.


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