Merger of GHSU and Augusta State University in Georgia

It was recently reported in The New York Times that several pairs of colleges and universities in the University System of Georgia are being merged, including Georgia Health Sciences University (GHSU) and Augusta State University (ASU).

http://thechoice.blogs.nytimes.com/2012/01/11/georgia-university-merge/

I earned the MBA at Augusta State University years ago and am presently a student in the Master of Health Informatics degree program at GHSU. I think two valid reasons to merge institutions are the benefits of synergy and the possible savings of money. Higher education is costly and the desire to reduce costs is understandable. My guess is that the motivation of the Regents for this merger is primarily based upon an anticipation of cost savings. Synergy can be achieved through shared services and cooperation among institutions.

It seems to me that mergers are more likely to be successful if the missions of two institutions are similar. Given that educational services are increasingly being delivered virtually (online), perhaps decisions about mergers should be based upon mission statements rather than geography. And, in any case, I wonder about the hope for cost savings. The resulting complexity of merged institutions may in fact lead to more costly operations. If institutions with different missions are merged, costs may actually increase while the focus of the institutions may be diffused.

In my experiences, both Augusta State University and Georgia Health Sciences University are good and valuable institutions. ASU is more a general-purpose state university, offering a wide variety of kinds of degrees. Augusta, Georgia is certainly large enough to need and merit such an institution. GHSU is, of course, focused on medicine and the administration of health care institutions. There are a number of valuable state universities in the Georgia system similar in mission to ASU. GHSU is a more specialized institution and is already complex in its administrative structures. There is going to be a period of adjustments and transitions resulting from the merger. I wonder if in the short term the quality of health care delivery in the state of Georgia and beyond may be affected while attention is diverted to some degree from mission to adjustment at both existing institutions.

In the long run, is the ASU campus going to become medically oriented throughout its existing degree programs and research? Is GHSU going to become less focused on medicine and healthcare administration? Or will the two institutions each remain pretty much as they are but operate under a single (highly stretched) administration? For starters, there is going to be a struggle to decide who who stays and who leaves among the administrative ranks. And what will the new entity be named? Will selected programs be merged at the college and departmental levels? GHSU just went through the process of changing its name from the former name, "Medical College of Georgia." The new name is intended to emphasize the mission and focus of the University. As a citizen of Georgia my major immediate concern regarding this merger is the continued quality of medical education and the continued quality of medical care. I wonder if in fact any cost savings will be realized by this merger and if the possible synergies might have be realized through the sharing of services rather than merger.

Financial challenges of private practice

I am posting this hoping that it will spark some interest and conversation in the foundations of healthcare administration course I am teaching this spring semester.

http://money.cnn.com/galleries/2012/smallbusiness/1201/gallery.doctors-broke/index.html

First responders risk lives solving health hazard mystery in Phoenix, Arizona

I am thankful to Chuck Mitchell, Chairman of the Dougherty Georgia County LEPC for distributing information about this video regarding the potential hazards of storage containers of liquid CO2 and the challenges faced by first responders.

Smarter than the average pixel?

What I understand of this TEDMED presentation by Dr. Eric Schadt is that it is not adequate to try to understand complex systems using simple linear thought (unless, of course, you are running for high political office). The part I am struggling to understand regards the idea that the causation of disease cannot be determined by studying populations of people and using statistical methods of analysis. Isn't epidemiology based on the notion that aggregate research designs can lead to insights into the causations of diseases in populations? And if an independent variable is important in the aggregate explanation for a disease or condition, isn't it likely to be important in the understanding of specific cases? It might be helpful to me to hear Dr. Schadt engage in a conversation with an epidemiologist about patterns of medical causations in individuals and populations.



It is the metaphor of the movie and the "average pixel" that I have not yet understood. Yes, there is no perfectly "average" patient. A specific instance of a disease or condition may be unique in causal origin. But I want to believe that understanding the health of populations sheds light on understanding the likely causes of instances of diseases/conditions. Patterns in complex systems are usually fractal in nature, meaning that the same patterns are evident at multiple scales. Perhaps I am trying to think too deeply about this or am simply missing some essential insight. Reader, I would welcome your comment that could shed some light.

Synthetic Biology and the future

I found the following video on Paul Levy's "Not Running a Hospital" blog. Engineering living beings is certainly exciting and filled with sober questions about what may be possible. I wonder about the applicability of our patent systems. I suppose that our legal scholars and others have already concluded that life (to a point) can be owned by those who "create" it.

Competition and costs of health care

Here is CNN special report by Professor Amitai Etzioni explaining why strategies to control rising healthcare spending are not likely to be constrained by plans based on competition.

http://www.cnn.com/2011/12/27/opinion/etzioni-health-care-competition/index.html?hpt=hp_c2

For all the reasons he cites, patients are not in a position to constrain healthcare spending. And even if they/we could, we would likely engage in cutting back on preventive care, driving up costs in the long term. It seems to me that every good policy initiative intended to save money has been turned in a way that contributes to continuing increases in costs. The reality is a very complex network of incentives. Whatever new policy is initiated, people are going to find ways to exploit the new system in unintended ways. Here in Albany, Georgia our largest hospital system has just acquired the other local hospital despite concerns by the Department of Justice and others that the acquisition will reduce competition and lead to higher costs. I suppose one approach to creating an Accountable Care Organization is to own all the necessary parts of one. I can imagine that the recent Patient Protection and Affirdable Care Act may encourage hospital system administrators to buy up their competitors to avoid the legal and other challenges of participating in the creation of an ACO.

Markets and governance

I am concerned by potentially revolutionary movements on both the right and the left side of the political spectrum in the United States. I am concerned that our system is broken and can longer able to generate rational solutions. Healthcare reform cannot be successful if transformation is impossible because of constrained resources and political failures. Those people who can cope with complexity are disadvantaged by our political system and are unlikely to win political office. I fear the resulting polarization and the social consequences.