Lakshminrusimha Satyan, Murin Susan, Galante Joseph M, Mustafa Zishan, Sousa Noel, Chen Stanley, Aizenberg Debbie A, Morris Elizabeth, Lubarsky David A
Acad Med. 2025 Apr 1;100(4):433-437. doi: 10.1097/ACM.0000000000005909. Epub 2024 Oct 30.
Academic medical centers struggle with the high cost of care, reduced reimbursement, intense competition, and low profit margins. Many factors, including a high proportion of publicly insured patients, a model rewarding procedural specialties, and research and educational support burden, led to faculty salary inequities, physician disengagement, and difficulty recruiting.
UC Davis Health implemented an aligned funds flow model in July 2021 to create a mission-aligned model in which all departments had financial margins to optimize recruitment, retention, research, and teaching.
The 3-year experience (academic years 2021-2024) with this model at UC Davis Health was characterized by physician compensation, physician recruitment, and profit increases. Total collections for departments increased by 4% in the first year, 0.2% in the second year, and 11.3% in the third year of funds flow. Total productivity increased by 4.9% during the first year, 3.6% during the second year, and 8.4% during the third year. Salaries increased in all departmental categories in year 3. Productivity and collections per faculty member increased during the first year and were stable during the second and third years. Parity among procedural, primary care, and hospital-based service lines was improved because departmental revenue was agnostic to payer mix and hospital agreements were more formulaic. The hospital contribution to funds flow increased from $67 million in 2022 to $101 million in 2024.
Regular communication and transparency are critical to ongoing trust and success with implementation of sustaining funds flow. The new model resulted in improved physician compensation and increased hiring. However, the implementation of funds flow had a negative fiscal effect on the academic medical center, and sustainability may require fine-tuning to balance affordability. The authors plan to convert outpatient primary care to productivity-based models and decrease time-limited support for new faculty from 2 years to 1 year.
学术医疗中心面临着医疗成本高昂、报销减少、竞争激烈以及利润率低下等难题。诸多因素，包括高比例的公共保险患者、奖励程序性专科的模式以及研究和教育支持负担，导致了教职员工薪资不平等、医生工作积极性下降以及招聘困难。
加州大学戴维斯分校医疗中心于2021年7月实施了一种对齐资金流模式，以创建一个与使命对齐的模式，使所有部门都有财务利润来优化招聘、留用、研究和教学。
加州大学戴维斯分校医疗中心在2021 - 2024学年采用该模式的三年经历呈现出医生薪酬增加、医生招聘增加以及利润增长的特点。各部门的总收款额在资金流的第一年增长了4%，第二年增长了0.2%，第三年增长了11.3%。总生产率在第一年增长了4.9%，第二年增长了3.6%，第三年增长了8.4%。第三年所有部门类别的薪资都有所增加。每位教职员工的生产率和收款额在第一年有所增加，在第二年和第三年保持稳定。程序性、初级保健和医院服务线之间的平等性得到改善，因为部门收入与支付方组合无关，且医院协议更具公式化。医院对资金流的贡献从2022年的6700万美元增加到2024年的1.01亿美元。
定期沟通和透明度对于持续实施维持资金流的信任和成功至关重要。新模型带来了医生薪酬的提高和招聘的增加。然而，资金流的实施对学术医疗中心产生了负面财政影响，可持续性可能需要微调以平衡可承受性。作者计划将门诊初级保健转变为基于生产率的模式，并将对新教师的限时支持从两年减少到一年。
