On Sept. 14, the second day of the UM System Board of Curators' meetings in Columbia, the curators discussed what changes in health care mean for the UM Health System.
UM Health System Vice Chancellor Harold Williamson Jr. presented an update regarding the system's pride points, budget and concerns about the Supreme Court's decision about the Affordable Care Act.
Williamson first discussed University Hospital's renovations, specifically its newly opened neuroscience unit.
"It's devoted to the most difficult neuroscience cases in our part of the state," Williamson said.
Though the UM Health System has not been in the red in net assets since the 2002 fiscal year, it was $10 million shy of its net revenues budget.
Williamson attributed this to a larger-than-projected decrease in admitted patients.
"That's a trend nationwide and regionally," he said. "The recession came along and probably decreased health care spending a little bit more. It changed the revenue in most hospital systems."
In addition, there is now a rapid shift from the more profitable inpatient care to outpatient care, Williamson said.
Some of this is because of the Affordable Care Act, which the Supreme Court upheld in June. The individual mandate on health insurance stood, which leads to a state-by-state insurance pool, Williamson said.
"Our state thus far has not decided if it would prefer a state pool or a national pool," he said. "But you, as a small employer, can purchase (insurance) at the same rate as a large employer."
There is also a new correlation between quality and reimbursement in the health care system.
Williamson said he heard on NPR heart surgeons aren't paid based on the quality of heart surgeries, but he said they are at University Hospital.
The Medicaid expansion, which decreases the barrier for underprivileged people to get into the program, also affects the health care system.
Missouri has not decided whether to opt in, Williamson said.
"Our challenge is that there are still lots of uncertainties with the ACA," he said. "We're not alone."
Revenue sources are projected to decrease during the next few years, and competition between health systems is expected to increase. This projection has led to conversations that already happened in the '90s with mergers, acquisitions and larger health systems, Williamson said.
"In the old way of looking at health care, we were looking at volumes: how many beds and admissions," he said. "The future will be about value. It's a new way of thinking from a consumer standpoint."
After a short recess, UM System President Tim Wolfe introduced Arizona State University President Michael Crow, who discussed what he thinks the focus of a public university should be.
In his introduction, Wolfe said Crow is known as a visionary who has guided ASU into the “New American University.” He said Crow has increased enrollment by nearly 60 percent. ASU now has more than 70,000 students, according to the Chronicle of Higher Education.
Crow, president since 2002 and ranked by TIME magazine as the fourth-best college president, said the university has achieved success by throwing out the idea of exclusivity.
“Can we produce a new model for an American university where we can measure ourselves not by who exclude but who we include?” Crow said to the board.
Part of doing this, Crow said, comes from not caring what other universities' ranks are or what other universities are doing.
“We’re done chasing the sled dogs in front of us,” Crow said. “The view is not that good.”
His presentation also emphasized ASU prides itself on letting in as many people as it can. If a student has a financial barrier or a problem getting into the university, ASU will find a way to make it work, Crow said. He admitted this presents inherent problems to the university.
But Crow said it’s not about the incoming grades — it’s all about outgoing grades. His presentation highlighted what a student does coming into college hails in comparison to what happens afterward.
“What our graduates go on to do defines success,” Crow said.
In the end, his presentation about “a new American university” emphasized change. Crow said it seems odd that universities try to be the same when everyone is unique, and that one can’t keep doing the same thing and expect it to change.
“It’s kind of like my wife says: ‘If you keep saying it, do you think that will make it so?’” Crow said.