How sequestration will hurt patients

It’s the kind of miraculous story that grabs headlines. Iraq War veteran Brendan Marrocco receives a rare, innovative double arm transplant. A team of surgeons from Johns Hopkins Medicine and Walter Reed National Military Medical Center come together at Johns Hopkins, a teaching hospital, a teaching hospital, to perform this complex procedure after many rehearsals and extensive preoperative preparations to ensure the surgery is successful and as safe as possible.

But behind the headlines of this remarkable achievement are the everyday missions of America’s 141 medical schools and affiliated teaching hospitals. Occupying a unique space in our nation’s health care system, these institutions (sometimes called academic medical centers) are where doctors and other health professionals are educated and trained, groundbreaking medical research is conducted, and medical firsts – like transplants – are pioneered and turned into every day treatments and cures.

If sequestration takes effect, these cuts will disproportionately impact the nation’s medical schools and teaching hospitals and the patients they serve. Only 6 percent of hospitals, major teaching hospitals, and their medical school physicians provide more than 20 percent of all hospital care in this country, 41 percent of hospital charity care, 20 percent of care to Medicare patients, and 25 percent of care to Medicaid patients. 

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At a time when teaching hospitals already face a broad range of reimbursement cuts from health care reform, so-called cuts to “providers” will mean cuts to patients. Sequestration’s 2 percent cut in Medicare reimbursements will mean that the average major teaching hospital will have nearly $14 million less to support critical patient care services often unavailable elsewhere in communities, including trauma centers, burn units, poison centers, and psychiatric units. 

More than 40 percent of all hospital patients today have an illness or injury that requires the more sophisticated level of technology and expertise only available at a teaching hospital. While most of us will never need these services, those who do — like victims of car accidents and gun violence—know how important it is to have a teaching hospital with a state-of-the art trauma center and expert physicians ready to provide care when a life is on the line. 

Sequestration also will hurt patients by cutting vital federal funding for medical research — $1.5 billion in the first year alone. NIH Director Francis Collins, M.D., Ph.D., says these cuts will be a “profound and devastating” blow at a time of unprecedented scientific opportunity. Medical research cannot be turned on and off like a spigot. Research interrupted by budget cuts, even for a few weeks, may mean years lost—years that could mean life or death for patients for whom medical research right now is their only hope.

Apart from sequestration, some in Washington want to cut federal support for doctor training to help reduce the deficit. But with our nation facing a serious shortage of physicians over the next decade, cuts to graduate medical education will mean that patients in the future may not be able to see a doctor when they need one. Both primary care physicians and specialists, such as oncologists, cardiologists, and children’s doctors, will be in short supply unless we take action today to increase federal support for graduate medical education and train more physicians. 

Medical schools and teaching hospitals are committed to doing their part to slow the growth of health care spending by developing new models of care that reward results, such as Accountable Care Organizations, as well as more cost-effective reimbursement models like “bundled payments.” They also are developing and disseminating best practices for reducing hospital infections, making surgeries safer, and ensuring that tomorrow’s doctors are trained in these new practices. 

Change is happening, but budget cuts that disproportionately affect patients at teaching hospitals will not only affect the vital care these institutions provide, they will slow their ability to make care better, safer, and more cost-effective. That’s a bad prescription for the future of health care.


Dr. Kirch is president and CEO of the Association of American Medical Colleges (AAMC), which represents the nation's medical schools, teaching hospitals, and academic societies. Prior to becoming AAMC president in 2006, Dr. Kirch served as the dean and academic health system leader of two institutions, the Medical College of Georgia and the Penn State Milton S. Hershey Medical Center. 

This post has been corrected from an earlier version.