CONFIDENTIAL
Duke Medicine Board of Visitors
Meeting Minutes
Duke Medicine Pavilion, 2nd floor conference room, 2W96
Friday, April 11, 2014
Board Members Present:
Christy Bell, P’08
Kirk Bradley, B’86
Santo Costa
Carol Deane, P’11
Victor Dzau, MD, P’09, Chancellor
Charles Hughes, P’94
John Karcher, P’87, ’90
Brandt Louie, P’00, ‘03
Charles McIIvaine, T’87
Robert Mercer, T’73, P’04, ‘07
Stelios Papadopoulos, PhD, P’08
Ruth Calvin Scharf, BSN’80
Anand Sharma
Michael Wilkins
Myles Wittenstein, T’59
Honorary Board Members Present:
William Anlyan, MD, HS’49-’55
Milton Lachman, P’74
Roslyn Lachman, WC’49, P’74
Sheppard Zinovoy
Leadership and Staff Attendees:
Nancy Andrews, MD, PhD
William Fulkerson Jr., MD
Susan Glenn
Lynda Heaney
Ellen Luken
Ellen Medearis
Sarah Nicholson
Kevin Sowers, MSN, RN
Kathi Warren
Dottie Williams
Guests:
Monte Brown, MD
Rob Califf, MD
Maggie Epps
Donald McDonnell, PhD
Bruce Sullenger, PhD
Eric Toone, PhD
Board Members Absent:
Leslie Bains, P’97, 00, Chair
Cathy Burns
Robert Ingram
Pat Johnson
David Katz, T’78, MD’83, JD
Garheng Kong MD, PhD’99, MBA’03
Donald Lacefield
Nicholas Leonardy, T’81, MD’85, P’08
Christy Mack, P’99, ‘01
Glenn Schiffman, T’91
Charles Stiefel, P’97
Stewart Turley
Honorary Board Members Absent:
Senator D.M. “Lauch” Faircloth
Thomas Gorrie, PhD
Thom Mayer, MD’77, P’08
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Welcome
Chancellor Victor Dzau welcomed the group on behalf of Leslie Bains who was unable to attend
the meeting.
Board Rotation
New Board of Visitors member Mr. Christy Bell was welcomed to his first BoV meeting. Mr.
Bell is the Chair of the Duke Nursing Board of Advisors. Serving more than thirty years in the
health care industry, he retired in 2012 as executive vice president for health care management
and president and CEO of Horizon Blue Cross Blue Shield of New Jersey’s statewide HMO.
Duke Medicine Board of Visitors Mission Statement
Reminding the group of the importance of their service, Dr. Dzau read the Duke Medicine Board
of Visitors mission statement.
The Board of Visitors is committed to facilitating the fulfillment of Duke Medicine’s Mission and
Vision by enhancing its standing as one of the truly outstanding academic health centers in the
world. As a group of committed donors, fundraisers, advisors and advocates this Board serves
as an overarching board to other Duke Medicine volunteer boards and assists the Chancellor for
Health Affairs, the Deans of the School of Medicine and School of Nursing and the Executive
President of Duke University Health Systems in developing and achieving long-range goals in the
priority areas of medical research, patient care, and medical education.
Development Update
Ellen Medearis reported on Board of Visitors giving. To date 22 of the 34 Board of Visitors
members have made their annual contribution to Duke Medicine. Recent leadership gifts
include:
•
A $1 million commitment from Mr. Glenn Shiffman and his wife Stacy to support
pediatric cancer research, including work by Dan Wechsler, MD, PhD, who is exploring
new treatments for childhood leukemia.
•
A $1.4 million gift from the Bravewell Collaborative to launch a leadership program
designed to prepare healthcare providers to practice integrative healthcare. Mrs.
Christy Mack is co-founder and president of the Bravewell Collaborative.
Ms. Medearis thanked those who completed giving pledge forms and Board of Visitors
Members Activity and Support forms, which were previously distributed to the board. She
went on to discuss the importance of planned giving, noting that the Duke Forward campaign
includes a goal of securing 1,200 planned gift commitments. Ms. Medearis noted the planned
giving materials in the board packets. She encouraged the group to explore opportunities
within planned giving and invited board members to contact Mr. Joe Tynan, Duke Medicine
Executive Director for Gift Planning, for more information.
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Following an introduction of Duke Medicine Development and Alumni Affairs staff, Ms.
Medearis reported that $790 million of Duke Medicine’s $1.2 billion campaign goal has been
raised. She noted that in campaigns, the last several hundred millions are the most difficult to
raise. More updates on progress towards the$1.2 billion goal will be forthcoming.
Special Constituent Patient Program
Ms. Maggie Epps, chief of staff for Dr. Dzau, joined the meeting to report on the search for a
successor for Ms. Courtney Ryon, who is retiring in August from her role as leader (and primary
staff person) of the Special Constituent Patient Program. Candidates for this vital patient
navigator position are currently being screened with the aim of filling the position before Ms.
Ryon’s departure in August. Ms. Epps encouraged Board of Visitors members to contact her if
they have any feedback or comment about the existing Special Constituent Patient Program or
suggestions for improvement moving forward.
Closed Session with Victor Dzau, MD
Dr. Dzau led a closed session with Board of Visitors members.
Update from the Executive Vice President, Duke University Health System
Dr. William Fulkerson provided an overview of opportunities and challenges currently facing
Duke Medicine. He noted Duke University Health System (DUHS) has avoided decreased
performance experienced by peer institutions due to a number of factors, including increasing
capacity for in-patient care. The opening of the new Duke Medicine Pavilion with its 160 bed
tower, along with an improved hospital transfer center enables DUHS to meet the demands for
critical care beds and inter-hospital transfers, something that had previously been a challenge.
Having the option and capacity to receive transfers from outside hospitals to both Duke
Hospital and Duke Regional has both hospitals seeing increases in inpatient discharges with
further opportunity for growth. Dr. Fulkerson went on to report that, despite the new
electronic health record system (Maestro Care) having initial challenges, it has been successful
overall, and it is anticipated it will provide improved insight into operational trends.
Further examinations of trends related to outpatient visits are underway. Duke Primary Care
patient visits are up, while specialty visits are under budget. It is estimated that weather may
have played a role in the lower performing specialty numbers – with approximately one week
of outpatient dates lost due to weather. The days lost have also affected surgical numbers. It is
anticipated that the lower numbers in specialty visits and surgeries will be made up within the
year.
Dr. Fulkerson went on to discuss financial results through the last nine months, stating that
operating income across the system is at $81 million compared to $94 million budgeted. The
discrepancy is attributed to three main factors including: engagement of Deloitte Consulting;
changes in the accounts receivables process (and revenue cycle) related to the new electronic
record system; and slower claims processing by Blue Cross Blue Shield due to their system
conversion. The budgetary discrepancies are temporary with two factors relating to electronic
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system conversions and one related to the engagement of consultants for the purpose of
improving budgetary margins by $200 million over the next three years.
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Presentation: Rankings, Research and Reputation by Nancy Andrews, MD, PhD, Dean, Duke
University School of Medicine; Vice Chancellor for Academic Affairs; Nanaline H. Duke
Professor of Medicine; Professor of Pediatrics; and Professor of Pharmacology & Cancer
Biology
Dr. Nancy Andrews began with an overview of the School of Medicine’s mission, including
research, clinical care, and education. She compared and contrasted the relationships
between rigorous research programs, rankings, and research funding, cautioning that no one
metric can be used in isolation to evaluate a program’s success. Rankings, NIH research
funding, number of scientific breakthroughs, publications, and awards shed light on program
success yet each metric comes with complex caveats. For example: rankings can be subjective
and often do not directly measure education quality or outcomes; NIH funding data does not
take into account the full extent of industry funded research (including research that is outside
of NIH); scientific breakthroughs and advances are often recognized or validated in retrospect
and can be hard to quantify; publications vary widely in quality, impact, and general interest;
honors and awards are important but often measure individuals more than research.
Dr. Andrews went on to explain the importance of ongoing efforts to increase research that will
lead to major advances and keep Duke competitive. Challenges facing the expansion of the
School of Medicine research program include lack of both research space and unobligated
funds to recruit research-intensive faculty members and build new programs. She detailed how
increasing funding of unobligated dollars would positively impact the research program.
$5 million (current amount of flexible funds available for initiatives each year):
• Enhance faculty recognition
• Increase interdisciplinary partnerships
• Provide leadership and grantsmanship training
• Provide services to enhance grant success
• Invest in IT processes, other efficiencies
• Provide partial matching support as required by NIH
• Retain our faculty stars (and prune unproductive research)
• Stimulate emerging efforts in strategic areas
$10 million in new support (above, plus):
• Enhance IT capability
• New rounds of Partnership Hires Program
$50 million in new support (above, plus):
• Build a new research building (naming opportunity)
$100 million in new support (above, plus):
• Build a bigger research building
• Recruit more mid-career stars (endowed chairs)
• Establish new signature areas
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$200 million in new support (above, plus):
• Go after more senior, Nobel-ready stars (expensive)
• Invest aggressively in existing and new signature areas
Update from Kevin Sowers, MSN, RN, Duke University Hospital President
Mr. Sowers discussed how Duke Medicine is responding to the changing health care landscape,
including the challenges and ripple effects created by the Affordable Care Act; Medicare
reform; insurers and large employers shifting more health care costs to consumers; the
reduction of government payments to hospitals; and the advent of a consumerism
environment, in which patients and their families make decisions regarding care based on costs.
In discussing the Affordable Care Act, Mr. Sowers explained that both consumers and providers
are in a learning phase with many uncertainties remaining. Though record numbers of North
Carolina residents signed up for health care during the health insurance exchange open
enrollment, it is unclear how many of those individuals have paid their premiums. Additional
uncertainty surrounds the consequences for providers who give service to those who seem to
be covered but in fact have not paid for coverage. The economic impact of this could have
further negative financial impact on health care systems.
Mr. Sowers went on to discuss Duke’s commitment to innovation and redesign of care and
delivery to meet the changing health care landscape. He noted the commitment extends to all
areas of the Duke Medicine mission including research, education, and clinical care. As
mentioned earlier, Deloitte Consulting has been engaged to assist with improving efficiencies,
including reducing expenses by $200 million over the next three years to help alleviate
anticipated financial stressors. Another component of Duke’s readiness plan is the creation of
Duke Connected Care, a community-based, physician-led network that aims to improve the
quality of health care while addressing the challenge of rising costs. Consolidation and
partnerships with hospitals across the region and the creation of new models of clinic-based
facilities to reduce emergency room visits are also part of the move towards greater efficiencies
and preparedness for the future.
In concluding his remarks, Mr. Sowers expressed concern about two significant challenges:
reduction of NIH funding and the reduction of Medicare funding. Sequestration created a $12
million reduction of Medicare funding to Duke Hospital, which will not be recovered.
Additionally, current and future researchers will be challenged to find funding for vital research
due to the reduction of NIH funding.
Duke Medicine Pavilion
Monte Brown, MD, Vice President for Administration for Duke University Health System and
Associate Dean of Veterans Affairs for Duke University School of Medicine, joined the group to
share details of the Duke Medicine Pavilion in advance of the optional tour at the conclusion of
the board meeting.
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Panel Discussion: Taking Ideas to Market
A panel discussion was moderated by Rob Califf, MD, Vice Chancellor for Clinical and
Translational Research, Director of the Duke Translational Medicine Institute, and Donald F.
Fortin MD Professor of Cardiology, with Donald McDonnell, PhD, Chair, Department of
Pharmacology and Cancer Biology and Glaxo Wellcome Professor of Molecular Cancer Biology,
Bruce Sullenger, PhD, Director, Duke Translational Research Institute and Joseph W. and
Dorothy W. Beard Professor of Experimental Surgery, and Eric Toone, PhD, Vice Provost and
Director, Duke Innovation & Entrepreneurship Initiative, Professor of Chemistry and Professor
of Biochemistry. The panel discussed the process of translating research discoveries into
knowledge and programs that can be implemented to prevent, diagnose, and treat disease.
They discussed the challenges of finding investors for early stage translational research, noting
that the $7 million to $10 million investment is the most difficult to secure in the early stages.
All agreed that Duke’s commitment to innovation, collaboration, and entrepreneurship has
been essential to advancing translational research and that, moving forward, an even larger
ecosystem of partnership needs to be created statewide.
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The Duke Innovation & Entrepreneurship Initiative, created to deepen Duke’s commitment to
support and encourage the translation of knowledge into action and service to society, has
been and will continue to be a valuable tool as funding resources become scarcer and as
investors require researchers to be more entrepreneurial. Professor Toone encouraged Board
of Visitors members to contact him to further discuss opportunities for involvement in the
Innovation & Entrepreneurship Initiative. He may be reached at [email protected].
Closing Remarks and New Business
Dr. Dzau expressed his gratitude to the Board of Visitors for their service, noting it has been a
privilege to work with them throughout his time at Duke.
Commemorative Photo
Following the close of the formal business meeting, board members gathered for a
commemorative photo. Copies will be sent to members as soon as possible.
Following the photograph, the meeting concluded at 12:40pm.
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