MEDICAL DEPARTMENT

Turmoil and change in the health care industry continue locally and nationally. The Medical Department has not been isolated from these events. Most notably, the illness and eventual incapacity of Mr. James J. Culliton, Vice President for Administration and our reporting VP, cast a heavy cloud over our activities. His efforts, through most of the year, helped guide us through significant changes in our internal and external relationships, and his constant attention to the spirit and the detail of personnel, financial and professional relationships will be remembered with great appreciation, admiration and affection. Mr. Culliton died on June 3, 1996.

The Blue Ribbon Panel completed its review of the Medical Department in April and we now await its report, which we re hopeful will be both supportive and productive. The strategic plan, completed during the prior year, has lead us in new directions, most notably, moving our surgical and medical activities to the Massachusetts General Hospital (MGH) in January, 1996 while continuing pediatric referrals to Children s Hospital, and Obstetrics and Gynecology at Brigham and Women s (B&W). We are currently developing contractural agreements with Partners (MGH, B&W and Dana Farber Cancer Center) that will result in significant savings in hospital costs. We are exploring the potential for use of peripheral satellite facilities associated with the larger Partners network. This initiative includes a marketing survey and evaluation of financial benefits and risks. Negotiations with Blue Cross have also resulted in significant savings in ambulatory medicine and technological costs.

These changes should help our financial position as well as provide our students and health plan members with outstanding tertiary medical care and the convenience of a facility literally across the Charles River. Our physician group has begun taking on the responsibility for care of hospitalized patients, providing essential continuity as well as efficiency. A bi-product of involvement in the robust MGH medical center is the opportunity for broadening continuing education through working with a variety of specialists, subspecialists, fellows and residents.

Finally, this introduction should not close without commenting on the impact of the early retirement incentive taken by seventeen individuals, representing 374 years of service to this department at MIT. Many of the individuals leaving are in key positions and we face the challenge and the task of restructuring, reallocating and recruiting. This is an opportunity, but it also represents a loss of valuable colleagues and the need for a significant effort to regroup and renew in ways salutary to our mission and to MIT s needs. We continue to seek the very best individuals to serve our community and its diversity as a highest priority. Joining the Department in July 1996 are an Hispanic American male and an Asian woman physician. In our current recruitment, we are very aware of the need to identify women and individuals of color and diverse ethnic backgrounds. We all learn from each other and contribute to the health and well-being of the MIT community.

MEDICAL CARE ACTIVITIES

Medical Service: William A. Ruth, M.D., Chief
This has been a year of transition and change and throughout this the internists continue to deliver high quality, personalized services to members of the MIT student and general community. There have been two resignations. Dr. Michael Myers left in the summer of 1995 and Dr. J. Christian Kryder cut back to part time and then retired from MIT in the autumn of 1995 to focus on a career in medical administration. We are currently in the process of evaluating a number of candidates to fill these positions.

Accomplishments have included computerization of all the medical offices. GroupWise E-mail has enhanced communication between individuals and among the entire staff. CD ROMs for Scientific American Medicine, Harrison s Text of Medicine, and the Electronic Library of Medicine have all been added to the system and have enhanced the ability of the staff to access articles and also to provide materials for patients with specific questions or problems.

The biggest transition has been the move from Mt. Auburn Hospital to the Massachusetts General Hospital which occurred in January, 1996. Members of the medical group are beginning to admit their patients to the MGH as primary physicians, or with the help of subspecialists provide continuing care with early referral back to the MIT Inpatient Unit or discharge home, whichever is feasible. A senior care program has begun to be explored and we are currently awaiting the resolution of some internal problems with Blue Cross/Blue Shield to complete the decision and planning of this program. A patient care survey has been completed and our patients continue to value the easy access to physicians. The role of the internists, the full-time commitment as well as assuming a variety of new responsibilities, has been a continuing effort. Quality improvement programs continue, including routine cancer prevention or early detection studies with mammography and Pap smears, as well as a focus on diabetic eye care evaluation and decision making in after hours services.

Off Hours Service: Leigh M. Firn, M.D., Coordinator
Emergency and urgent care for patients in the MIT community is provided on a 24-hour basis by the Off Hours Service, staffed by a roster of department internists, nurse practitioners, and moonlighting internists and pediatricians from the leading hospitals in the Greater Boston area. The patient volume has stabilized, but to reduce patient waits, a same-day appointment system was introduced and staffing has focused on traditional peak patient hours. This has resulted in fewer long waits and a much smoother flow of patients which has enhanced patient satisfaction as well as provider efficiency. As part of our effort to improve the standard of care, we continue to assess our needs, do focused review of medical problems that are seen in the Off Hours Service, update our equipment and medications, and educate our staff in emergency procedures including advanced cardiac life support.

Inpatient Medical Service: Elaine Shiang, M.D., Chief
The Inpatient Unit continues to play a vital role in the care and management of MIT patients. There were 707 admissions this past year which include student, affiliate, health plan, Medicare and fee-for-service admissions. In addition, the Clinical Research Center had 452 inpatient days, a 300% increase from the previous year. The recent renewal of Health and Human Services 4-year grant promises to continue the CRC admissions at a steady rate or possibly an increase. Areas of research include metabolic, nutritional and sleep studies. The new relationship with Partners Health Care and the Massachusetts General Hospital is progressing well. Continuing efforts are being made to ensure that all aspects of patient care between MIT and Partners hospitals is of the highest quality. Patients who require acute hospitalization will be transferred back to our full-service hospital at the earliest possible time, through improved communication and MIT physician input.

Obstetrics and Gynecology Service: Lori A. Wroble, M.D., Chief
The major staffing changes this past year included the loss of Dr. Carey York to become full-time at the Massachusetts General Hospital and the hiring of Dr. James Marquardt as a full-time provider in July 1996. Dr. Marquardt, a B&W staff member, has been familiar with our obstetrical activities at the Brigham. The statistics for 1995-1996 included 8,400 visits and 170 deliveries. There was a 12.9% Caesarian section rate and there were 52 GYN surgeries of which 30 were major. Karen Halvorson, R.N.C., has continued her role as coordinator and co-chair of the highly successful and appreciated Infertility Consult Committee, which is made up of a group of individuals expert in advising patients with infertility problems. Our OB/GYN physicians have applied for clinical privileges at the MGH. This will allow us to do occasional GYN consults on MIT Health Plan patients who are on the medical or surgical services at the MGH. We have worked to improve our services to patients, to find areas to cut costs, and have had ongoing meetings with the Chief of the Obstetrics Service at the Brigham and Women s to accomplish those ends.

Pediatric Service: Mark Goldstein, M.D., Chief
A pediatric resident rotation with the Massachusetts General Hospital was initiated. Monthly clinical sessions for pediatricians and a nurse practitioner have been instituted and the efficiencies in the administration of the Pediatric Service to improve patient and staff communications have been enacted successfully. A new pediatrician, Dr. Ellen Bass, trained at Georgetown Medical School and Yale New Haven Hospital began practicing last summer and has added to the responsiveness of the service. Efforts to communicate with non-English speaking parents and patients were strengthened with written materials in their native languages and the use of a Japanese-English computer. Efforts at communication with the diverse international students will continue to be explored.

Psychiatric Service: Peter Reich, M.D., Chief
Frequency of hospitalization in outside facilities and the MIT Inpatient Unit remained similar to last year. Inpatient days in outside hospitals actually decreased secondary to shorter hospitalizations. Psychiatric ambulatory visits once again reached a record level, slightly higher than the level of utilization the prior year. We have continued to have trainees from the Harvard Longwood Psychiatry residency training program and this continues to be successful for the trainees while enhancing their contributions to the clinical psychiatric services. This year marked the retirement of four long-time members of the mental health program, Jacqueline Buck and Myra Rodridgues, L.I.C.S.W.s, Charlotte Schwartz, Ph.D. and Peter Jenney, M.D. In addition, Dr. Elizabeth Childs accepted a position as Chief of Psychiatry at Carney Hospital and leaves the Department after providing excellent consultative care in child psychiatry.

Community service was again a major part of the work of the Psychiatry Service in health education, in weight reduction, cancer awareness, wives groups, committee on academic performance, consultation to Institute administrators, and serving as advisors to the MIT student night-line program.

Social Work Service: Ronald C. Fleming, L.I.C.S.W., Chief
The Social Work Service remains principally a direct provider of community mental health and medical social work services. An estimated 700 people were assisted this year. For students and especially for members of the MIT Health Plan and MIT employees, the Social Work Service continues to provide direct on-site clinical services including Lincoln Laboratory. Through the use of groups, creative and flexible response to community needs is met. Groups are an efficient way of providing assistance and in general have been enormously well received including in areas such as cancer and alcohol abuse. There are a variety of self-help organizations that use the social service department as a clearing house, including Alcoholics Anonymous, Overeaters Anonymous, Co-Dependents Anonymous, etc.

In addition to the clinical services, community social work is a vital part of what we provide. Minority student concerns are addressed in the minority student concerns group and in the summer science programs. The staff participated in a special program for African American administrators, a meeting that brought together veteran staff with newcomers. Elder care issues are a growing concern in this community and specialized educational seminars as well as group activities have been successfully developed. Social work staff members participated in several forms of community education and consultation, the most significant being to the administrative offices group and the family resource center. The Institute Personal Assistance Program (IPAP) celebrated its 17th year and provided on-site employee assistance to the community.

Members of the Social Work Service also contribute to numerous activities within the Medical Department. It should be mentioned that the loss to the Service of Myra Rodrigues and Jackie Buck to the early retirement program leaves an enormous void, for these two individuals have served the Institute for a total of 56 years. Both have been especially sensitive to the needs of families, student families, foreign students, and their families, minority students and staff, as well as other members of the community. Their loss will be deeply felt by many within the Department and throughout the MIT community.

Surgical Services: Stephen J. Healey, M.D., Chief
The volume of patient visits has remained stable. Minor surgeries numbered 250 procedures. In addition, approximately 150 major surgical procedures were performed at Mt. Auburn Hospital during the year. Transition to a primarily MGH related general surgical activity is now under way and with the early retirement of Dr. Stephen Healey, Dr. Larry Geoghegan from MIT and several individuals from the MGH General Surgical Services will be providing surgical care.

Nursing Service: Janet V. Beyer, RNC, Chief
The Nursing Service provides nurse practitioner services in the internal medicine clusters at the Medical Department, the after hours service and Lincoln Labs, as well as in subspecialty areas such as dermatology and psychiatry. The Inpatient Unit continues to extend exceptional care to our patients. The Lincoln Laboratory clinic is staffed primarily by Monique Canton and a total of almost 3,000 patients were seen this year. Community service continues to be an important function of the Nursing Service, including graduation and alumni week activities, freshmen orientation, screening physicals, various vaccination clinics, and also activities during IAP and Health Plan open enrollment. Nurse practitioners now have prescription writing privileges. All providers have a co-signing MD and a log book of all prescriptions written and these are reviewed at frequent intervals. Involvement in their own continuing education has been a significant part of the Nursing Service s activities. This is the last year that Janet Beyer will serve as Director of Nurses and it is with regrets and with great appreciation that this report is provided for the annual report.

OTHER DEPARTMENT ACTIVITIES

Environmental Medical Service (EMS): Robert J. McCunney, M.D., M.Ph, Director
The EMS continues to thrive. The Director assumes responsibility in clinical oversight of medical surveillance programs for a variety of MIT personnel including those exposed to asbestos, berillium, lead, and other hazards in the course of their work. Within the past year, a medical surveillance program for animal handlers has been established to assist the Department of Comparative Medicine in meeting a regulatory audit for the summer of 1996. Clinical evaluations are performed for a variety of regulatory requirements including those related to respirator use, tower climbing, confined space activities and for evaluation of a variety of symptoms that may be related to work. In addition, educational and research services and activities are provided through the office of the Director of EMS. For example, an EMS co-sponsored meeting with MediChem, part of the international commission on occupational health, entitled The Chemical Industry as a Global Citizen: Balancing Risks and Benefits was held on campus for over 200 people representing 40 countries. A physician s guide to emergency response to be published later this year in the Journal Occupational Medicine involved research studies that were undertaken at MIT. Another research study involved biological monitoring methods associated with inadvertent ingestion of radioactive P32.

In addition to the Office of the Director, the Biosafety, Industrial Hygiene, and Radiation Protection Offices all were involved in major service and research activities on campus. These activities included studies of generic blood borne pathogen exposure control, the expansion of the Whitehead Institute with documentation of waste management planning and training, assistance to the American Biosafety Association for their meeting in Boston, and the extension of the QA and QC program to include animal care in the Department of Comparative Medicine. A systematic program to respond to and correct indoor air quality complaints in a timely manner was undertaken, and the group participated in several of the academic courses providing health and safety education to engineering and science students. In the area of radiation protection, all three radiation protection office divisions, campus, Bates Lab, and reactor continue to maintain all established training personnel monitoring radiation survey, radioactive waste management, record keeping, authorization review, radiation committee support in emergency response programs throughout the past year. Major achievements have included waste disposal management, radioactive material ingestion dosimetry evaluation and security of radioactive materials stored on campus.

Health Education Service (HES): Jessica Goldhirsch, M.P.H., Director
Health Education has enjoyed a productive year of growth and expansion with the coming of a new Director as well as physical renovations of the resource center and library, allowing for expanded topics and up-to-date information as well as easier access for the community. New fall and spring health promotion classes, with a focus on stress reduction and complimentary therapies, were provided and met with enthusiasm. Under the leadership of Sally Ciampa and the guidance of Dr. Margaret Ross, Health Education coordinated the Medical Department s successful representation at IAP with over 72 lectures serving more than 1,600 people. Under the direction of Tracy Desovitch, the student liaison and education program MEDLINKS added a second 20-hour training in January bringing the total of new student members to 62. Highlights of the year included the KISS (Keeping Intimacy Safe and Sensual) Health Fair, a World AIDS Day observance, and numerous well received workshops by the peer education drama troupe, UpFront, and the prefinals health expo. With guidance from the nutrition service, a student intern worked with the MEDLINKS group. Working with MEDLINKS group, CHEW (Choosing How to Eat Well) to forge a new relationship with MIT Food Services, resulted in a new specially designed menu during finals week. The work of the MEDLINKS program included the expansion and refinement of the mentors program, resulting in 18 medical staff members becoming involved in visits to student living groups to learn more about student life and to provide health education. Under the leadership of the new director, Jessica Goldhirsch, and with the continued guidance of the Health Education Advisory Group, new marketing plans are under way that direct people to health education, to new literature displays and new publications. Relationships with the Family Resource Center, the Dean s Office, Environmental Medical Services, the Women s League and retirement community have been strengthened.

Lincoln Laboratory Medical Service: Bruce J. Biller, M.D., Coordinator
Staffing of the clinic has continued to be provided by a nurse clinician, a secretary and by Dr. Biller. Patients are seen daily by the nurse practitioner and a single afternoon a week by the M.D. Quarterly monitoring of routine and emergent care is reported to the Quality Improvement Committee of the Medical Department and patients requiring medication or prescriptions are reviewed each week. Consultation for the nurse clinician has also been provided for those patients seen who need diagnostic evaluations. Pharmacy prescription service using the Lincoln shuttle is provided at great convenience to patients; and specimens can be delivered to the MIT Laboratory.

Student Health Service (SHS): Mark A. Goldstein, M.D., Chief
The first ever pre-matriculation survey to determine use of alcohol during the last year of high school was completed with the freshman class entering in September 1995. Compared to the national average of 30% of high school students having binge drinking episodes in the prior month, 7.5% of the MIT students reported similar activities. Preliminary results of another study indicated that students entering MIT at age 16 did not utilize the Medical Department any differently from students entering at age 18. An article on the importance of hepatitis B immunization for adolescents was supported by an educational grant to Dr. Goldstein. Its co-author was a former MIT student, now at Yale Medical School. It appears that increasing numbers of physicians are immunizing all adolescents against hepatitis B and after publication of the above article, the Massachusetts Department of Public Health began to sponsor administration of the vaccine in Grade 7.

Input from student members of the Student Medical Advisory Council helped to redesign brochures about the Medical Department and based in part on suggestions from students, hours were extended on Tuesday evening to 8:00 PM for members of the MIT community which includes students often busy in daily class activities.

The Definitive Guide to Medical School Admission written by Dr. Goldstein and his spouse and based on his 18 years of pre-medical advising was published and made available to students in the M IT community.

The Pharmacy benefit for the MIT student insurance plan was initiated and for a $6 co-payment, students under the plan receive up to a month s supply of prescription medication from the Pharmacy. For Dr. Goldstein s continued activities in student health, he has been appointed to the Massachusetts Medical Society School Health committee.

Clinical Operations and Administration: William M. Kettyle, M.D., Associate Medical Director
An affiliation with the Partners Health Care Network was a major administrative undertaking for the MIT Medical Department. Driven by the need to ensure excellent care at reasonable costs, a thorough search of the best courses of medical care for services outside the Medical Department was undertaken. Discussion with local area hospitals and health care delivery systems included a careful look not simply for excellence, but also for ease of use by our patients and physicians. By focusing the care of our patients at a smaller number of institutions and by including the use of our inpatient unit in the planning and negotiations, an agreement was made that should save a significant amount of money.

The affiliation required moving our principal place of hospitalization for medical and surgical patients from the Mt. Auburn Hospital, an institution that had served us well for a number of years, to the Massachusetts General Hospital. This change also led to the involvement of our physicians in the acute care mangement of our hospitalized patients. This will allow closer control of resource use, maintain a high degree of continuity of care and facilitate the use of our inpatient unit as a subacute facility. The affiliation went into effect on January 1, 1996 and has been implemented smoothly. Overlapping arrangements have allowed a graceful transition for both patients and staff.

The early retirement program has resulted in a significant reduction in some key patient care positions. While some positions will absolutely need to be refilled, we are actively seeking ways to meet the needs of our community without simply rehiring all those who have retired. The retirement of 17 individuals, 14 of whom had direct clinical responsibilities, presents a significant challenge and an opportunity to rethink how patient care can remain excellent and still be delivered in a convenient cost-effective manner.

In addition, efforts are under way to assess our information system needs both current and for the future. It is vital that we have the data necessary for the decisions that face us daily in the rapidly changing health care environment.

The Medical Department staff continues to play an active role in the activities of the campus. Pre-med advising, teaching of medical students and medical engineering students in the HST program continue to be important tasks undertaken by the Medical Department. Providing speakers for IAP and mentors for the MEDLINKs program continue to be important functions served by the Medical Department.

MIT Health Plans: Mary P. Smith, Director
The MIT Health Plans, as in years past, continue to have more than 50% of the MIT employee base as subscribers in the Traditional and Flexible plans even as the overall employee numbers decrease at the Institute. While it is important to maintain that 50% base, it also becomes necessary to find ways in which to increase the plans enrollment and ensure the long-term viability of the plans.

The Health Plans managers have been meeting with representatives of Blue Cross & Blue Shield to explore more favorable payment rates for hospital and physician services. Plans are under way to implement HMO Blue payment rates for all services rendered outside of the Medical Department. This process involves physician credentialing, developing care management protocols with Blue Cross & Blue Shield and other operational details. It is hoped that these favorable rates will be in place by September 1, 1996.

Continued cost pressures, demand for additional benefits and competitive premium rates among all plans offered by MIT will challenge the Health Plans during the next open enrollment period.

Administrative Operations and Management: Annette Jacobs, Executive Director
Administrative activities in the Department have focused on supporting the clinicians during our change of hospital affiliation and providing the Blue Ribbon Panel and the Institute with financial and statistical data regarding the Department s activities.

The change in hospital affiliation from Mt. Auburn to Partners (MGH and B&W) involved major financial negotiations which will allow us to substantially decrease our costs for acute care hospitalization without reducing or changing the way we provide service. We have coordinated with MGH staff and many support service areas including medical secretarial, Medical Records, Pharmacy, Lab, and X-ray to assure smooth and seamless patient care and identify and resolve problems instantly.

In support of the Blue Ribbon Panel, we have continued to refine our methodology for defining lines of business with profit and loss statements for each. These profit and loss statements will become part of our annul financial reporting. We continue to develop reports at a more detailed level by service, by physician, and by activity to allow us to monitor costs and reduce them appropriately.

With the help of outside consultants, we are engaged in market research related to our strategic plan. We will be surveying organizations begun by MIT alumni and faculty in the greater Boston area to ascertain interest in offering our health plans to their employees. In the fall, we will be conducting a telephone survey of employees (both Health Plan and non Health Plan members) to determine the feasibility of and best locale for possible satellites.

Lobby renovations, which have been in planning during the year, will begin just after Commencement in June. We expect the new lobby to provide a more welcoming, warmer, and safer environment on our first floor.

PERSONNEL CHANGES

Terminations
Marcia Austin - Assistant Radiation Protection Officer
Barbara Frank - Administrative Assistant
Susan Katlove, M.D. - Psychiatrist
John Kryder, M.D. - Physician
Kathleen Maloney, R.N. - Manager, Quality Improvement, Utilization Review, Risk Management
Michael Myers, M.D. - Physician
Lisa Newfield - Manager of Special Projects
Nancy Sidhu, Ph.D. - Clinical Psychologist
Ronald Tracy, D.M.D. - Dentist
Andrea Wilson, M.D. - Fellow, Psychiatry
Bruce Wood, D.P. - Podiatrist
Changes
Kin Lye - Consultant (Promotion)
Mary Smith - Director, Finance and Health Plans (Promotion)

Retirements
Janet Beyer, R.N.C. - Director of Nurses
Barbara Bidstrup, R.N. - Inpatient Nurse
Jacqueline Buck, L.I.C.S.W. - Social Worker
Robert Burgess - Radiation Technician
Michael Erard, O.P.A.-C. - Orthopedic Assistant
Charles Hatem, M.D. - Physician
Stephen Healey, M.D. - Surgeon in Chief
Peter Jenney, M.D. - Psychiatrist
Helen Katz - Administrative Assistant
James Manson, M.D. - Orthopedic Surgeon
Barbara Merrifield, C.N.M. - Nurse Midwife
Elaine Miller - Dental Service Coordinator
Myra Rodrigues, L.I.C.S.W. - Social Worker
Beverly Scarlett - Admin. Secretary
Charlotte Schwartz, Ph.D. - Clinical Sociologist
Arthur St. Andre, R.N.C. - Nurse Practitioner
Marcia West, R.N., C.P.N.P. - Nurse Practitioner

Our basic commitment continues to be the provision of quality medical care to the MIT community. To do this while maintaining a low barrier and keeping costs down has become a difficult task but remains a worthy objective. Health care includes prevention, education and early intervention by dedicated individuals with values that resonate with those of this community. We are making progress to modernize our information systems, to work through a strategic plan that has many operational as well as innovative components, and to reduce our costs without any compromise of quality and availability. Through the hard work of many dedicated individuals we anticipate continuing progress on many fronts while we deal with the every-day issues confronting our multi-faceted department. Our preparations for the visit by surveyors of the Joint Commission on Accreditation of Health Care Organizations in October 1996 give us great confidence that we are making progress.

Arnold N. Weinberg, MD

MIT Reports to the President 1995-96