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Wednesday, November 18, 2015

Wednesday, November 18, 2015

This Week At The Regents (II): The Medical Centers and University Governance

As I mentioned in my post on the Budget, the Regents will be considering a proposal to alter the governing structure of the medical centers.  This proposal is a somewhat improved version of an earlier, and admittedly worse, plan that was presented at the Regents September Meeting.  The effects of these plans will be to give the Executive Vice-President--Health greater authority, to increase the ability of the medical centers to influence the Regents more directly, and to grant greater autonomy to the health care system more generally.  In both its substance and its creation it points to serious problems in UC's internal governance.

First as to substance.  The proposal will expand both the size and the authority of the Regent's Committee on Health Services.  It would be continue to have six Regental members but would now include the Executive Vice President--Health, two Chancellors from campuses with medical centers, four outside "experts" effectively chosen by the Executive Vice-President--Health, and one faculty member from a medical center to represent the Academic Senate.  These eight new individuals would be non-voting members.  The Committee would have increased autonomy regarding transactions up to certain limits (5) including those relating to compensation. (1)  The Committee's opinion would be required on capital projects that could affect the Health System. (4)

Now as I said, this proposal is an improved version of a proposal first floated at the September Regents Meeting.  In that earlier proposal, the Executive Vice-President--Health and the two Chancellors would have been voting members.  In addition, they would have been granted "primary responsibility" for UC Health capital projects.  (5).  This set up raised the possibility, given the size of the committee and quorum rules, that the Executive Vice President--Health and the two Chancellors might establish a committee policy because only two Regents were in attendance.  Nor was there any proposal for faculty input.  In the end, Regents at the September meeting did voice skepticism about these proposals and the Academic Senate strongly opposed the plan.  The result is the modified version we have now.

Still, there is no reason to throw laurels.  For one thing, one point stressed by the Academic Senate and not addressed in the revisions is the all but complete disregard for either the teaching or the research components of the UC Medical Centers which are, after all, university medical centers.  This plan pushes those concerns aside for an emphasis on the business of health care.  But unless one can include in strategic planning the teaching and research elements of the UC Medical Centers it is unclear what the medical centers are doing as part of the University.  Medical faculty I have spoken with are deeply uncomfortable with this aspect of the new plan.

There is one perhaps even deeper issue here.  The proposed changes are based in a Rand Study begun in the middle of March 2015, completed in June 2015 and based on review of some of the analytical literature, interviews with UC and UC Health Care Administrators as well as some administrators from other academic medical centers and publicly accessible UC documents.  (2-3) The study's authors acknowledge that due to "the short timeline of the effort, a detailed analysis of the AMCs’ finances and operations was beyond the scope of this project." (3) The heart of the report is really about the problems of communication and lines of authority within UC Health Care.  Yet on the basis of a rushed report that was unable to do a detailed analysis of how the system actually worked and raised all sorts of internal issues, UCOP is proposing to increase the authority and autonomy of the medical centers.  I can understand why the medical center administrators would want greater authority and autonomy but is this any way to make policy? What about the impact on the campuses and the University as a whole?

The end result, then, is that thanks to push back from some Regents and the Senate a poorly constructed and rushed policy has been replaced by a modestly improved proposal.  But the proposal is still based on the shaky foundations of the Rand research and the claims of the Medical Center administrators.  Once again, the Senate has been put into a position of trying to improve a policy proposal that should not have been made in the first place.   Instead, the serious issues that face the Medical Centers in the new world of the ACA should have been carefully studied--studied by the many faculty experts on health care that are at UC.  Unfortunately, like too many other issues in the recent past, UCOP did not identify a problem and engage with the faculty in a shared search for possible solutions.  Instead it presented a proposal and left the Faculty to smooth out the edges.  The Senate remains on the defensive and well thought-out solutions remain over the horizon.


Anonymous said...

It's "pushback" not "push back." Proofread before you post.

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