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Shape Shifting the Matrix Model: OSU/James Hospital Structure May Emerge Stronger Following Institutional Infighting

Rosenthal, Eric T.

doi: 10.1097/01.COT.0000305574.26166.dd
Eric Rosenthal reports

While most institutions attempt to keep their dirty laundry hampered until cleaned and presented to the press, sometimes the still-soiled is aired publicly before undergoing thorough sanitization.

The controversy conflicting Ohio State University's Columbus campus hadn't really been a contained “dirty little secret,” according to a senior university official, but its public unveiling in late August drew attention to the larger issue of the inherent friction between matrix cancer centers embedded within university settings (see accompanying story).

When consulting firms Deloitte & Touche and Hammes Co. released their respective reports reviewing the relationship between Ohio State's Medical Center and Arthur G. James Cancer Hospital, especially with regard to the master space plan and finances, the daily news media reported that the consultants cited that “infighting” could discourage “topnotch faculty and scientists” from joining either program, and that “sufficient dissent and concern exists” to recommend that both parties work together to build “the necessary alignment in order to proceed effectively.”

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Largest Building Project in History of Ohio State

Together, the two firms were paid more than $770,000 to determine different aspects of the direction of the $780 million medical center expansion—the largest building project in the history of Ohio State, which is the nation's largest university.

Consideration was given to financial and patient issues and stemming the potential delays that will push the building project past its 2011 target completion date, as well as to quell the fears of the cancer center's dedicated donors who wrote in January to then-OSU President Karen A. Holbrook, PhD, about changes being made by the Medical Center's CEO, Fred Sanfilippo, MD, PhD, who was also Senior Vice President and Executive Dean for Health Services.

Dr. Holbrook retired in June upon completing her five-year term.

Dr. Sanfilippo (who had been interviewed by OT about academic-industrial alliances in the January 25, 2007 issue) announced in July that he would be leaving OSU to become EVP for Health Affairs, CEO of the Woodruff Health Sciences Center at Emory University, and Chairman of the Board of Emory Healthcare.

His position at OSU is still unfilled by a permanent CEO or senior VP and executive dean.

OT contacted Emory about speaking with Dr. Sanfilippo, but was informed by Emory's Health Sciences Communications Office that the request should be directed to OSU Medical Center's chief communications officer. OSU followed up with an e-mail saying that they contacted Dr. Sanfilippo, who said, OSU explained, that given that he is no longer with OSU that we should talk with OSU leadership, “who can just as easily articulate the issues as he could.”

OT did speak with Michael A. Caligiuri, MD, Director of OSU's Comprehensive Cancer Center; David E. Schuller, MD, CEO of the James, and a number of other individuals who preferred not to be identified.

Numerous attempts to speak with the university's newly installed and also former President, E. Gordon Gee, PhD, were continually postponed by the university, which didn't follow through with a scheduled interview.

Dr. Gee returned to OSU this summer after serving for seven years as Chancellor of Vanderbilt University. Said to have held more university presidencies than any other American, Dr. Gee had been OSU's president from 1990 to 1997.

His address to the Faculty Council in early October was reflective of the university's efforts to encourage a healing process when he expressed his one-university vision by saying, “First let us forge one Ohio State University. Let us begin to think of ourselves as the university, not a collection of colleges hitched to a heating plant, or a detachment of departments connected by corridors.”

OT did learn through various sources that the governance of the OSUCCC is expected to change within the near future, with the possibility of going back to an earlier model by placing both the Cancer Center and James under single leadership.

As of press time for this issue, neither Dr. Caligiuri, Dr. Schuller, nor the university would comment officially about specific changes, but Dr. Schuller did add that the cancer center's new governance was "a work in progress" and contingent upon other governance changes at the university level.

Figure. E

Figure. E

Since Dr. Gee arrived at OSU, both Drs. Caligiuri and Schuller report directly to him and the James's Board of Directors, thus bypassing the medical center hierarchy, which is a requirement of the prospective payment system (PPS) exemption OSU now enjoys.

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‘Unique, Hybrid, Freestanding-Matrix Cancer Center’

Dr. Caligiuri explained the history of the intra-campus controversy and how its resolution may create a unique, hybrid freestanding-matrix cancer center that could bridge the best aspects of both cancer institute models.

At the time of his interview in October, Dr. Caligiuri was Director of the cancer center and Deputy Director of the James, and David E. Schuller, MD, was Senior Executive Director of the James and Deputy Director of the cancer center. Dr. Caligiuri is also Vice President and President-elect of the Association of American Cancer Institutes.

Dr. Caligiuri described their relationship as working “hand in glove, especially since Dave had been the former cancer center director and has been nothing but a great partner.”

Dr. Schuller was head of both the cancer center and hospital until 1997 when Dr. Caligiuri and Clara D. Bloomfield, MD, were recruited to Ohio State from Roswell Park Cancer Institute by OSU President Dr. Gee during his first stint as university CEO.

Dr. Bloomfield became cancer center director, and Dr. Schuller maintained his leadership of the hospital.

In 2003, Dr. Caligiuri succeeded Dr. Bloomfield (who became OSU Cancer Scholar and Senior Adviser to the cancer center) as director and established his reciprocal partnership with Dr. Schuller, with both positions reporting to Dr. Sanfilippo and the university's Provost.

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Project Cancer

That same year marked the launching of Project Cancer—a university commitment to a huge expansion of the cancer center's clinical and research facilities, including the construction of a 288-bed cancer hospital and some 160,000 square feet of research space.

“It was to be an enormous facility and largely funded by the cancer program itself utilizing the bonding capacity of the university,” Dr. Caligiuri said.

“So importantly we were given permission to build Project Cancer, but also given responsibility to pay for it through revenues from the cancer hospital as well as fund raising.”

He added that during a 17-year period the cancer center had dispersed about $168 million in funds throughout the Ohio State campus.

The new center would also focus on basic, translational, and clinical research; education, and patient care—components critical to NCI-designated comprehensive cancer center status.

However, that commitment changed in 2005 when the medical center's larger expansion program engulfed the agreed-upon future of Project Cancer, causing alarm among some of the James's backers who feared loss of the hospital's freestanding status, which could adversely affect the cancer center's prospective payment system (PPS) exemption, and cost it about $10 million to $15 million a year.

Dr. Caligiuri said that Ohio State's cancer center was only one of 10 cancer institutions in the nation considered as freestanding and therefore exempt from the Centers for Medicare and Medicaid Service's PPS.

He added that PPS guidelines also required that exempt centers be “hospitals-within-hospitals,” meaning that they had to have a separate governing body that is not controlled by the hospital or academic medical center it is part of, a separate chief medical officer, separate medical staff, a chief executive officer, and performance of separate hospital functions.

OT learned that there were also potential plans to separate the research component and clinics from the new hospital, a proposal that would be both antithetical and crippling to the concept of comprehensiveness.

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Board of Trustees' Primary Objectives

There was a certain irony to these plans since they contraindicated some of the university Board of Trustee's primary objectives for the medical center as presented in August by the Medical Center Governance Task Force:

  • To position the OSU James Cancer Hospital and Solove Research Institute (“the James”) to become a top 10 NCI-designated Comprehensive Cancer Center.
  • To maintain the excellence and growth of the OSU Medical Center, both in programs, personnel and facilities, through a sound strategic investment plan.
  • To maintain the James Cancer Hospital's federal PPS exemption.
  • To enhance interdisciplinary synergies among the University Medical Center, the James, and Ohio State University.

Dr. Caligiuri said he had been seriously considering leaving OSU, and was one of two candidates for the cancer center directorship at Johns Hopkins; but when Dr. Gee returned to the university the center's proposed restructuring provided adequate reason for retention, and Dr. Caligiuri withdrew his name from the Hopkins' search.

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Findings by Local Newspaper

Although those contacted by OT were reluctant to discuss some insider details related to the university controversy, an article by Dan Williamson appearing in Columbus's Other Paper in March provided some insight into the infighting.

“Top Doc on the Rocks—Fred Sanfilippo might be the most powerful person at Ohio State. So how can his job be in jeopardy?” described how Dr. Sanfilippo transformed OSU's in-debt hospital system into a profitable and nationally recognized medical center, but managed to make “the wrong enemies.”

The article referred to the letter sent by cancer center backers in January to OSU President Holbrook as “what may well turn out to be the last straw for Sanfilippo….”

“The impassioned letter…accused Sanfilippo of growing the medical center at the expense of the James and undermining the hospital's ability to raise money and retain talent.”

The Other Paper reported that the letter read as follows, “We must prevent this from happening! We cannot afford to allow the Medical Center leadership to pursue a dangerous path which in our view undermines the James's ability to build and enhance its clear record of excellence.”

The article pointed out that the James was a “sacred cow in Columbus,” and some of the city's most prominent and influential citizens were among the signers of the letter. The cancer hospital had also become a “very successful fundraising machine,” and there was concern that Sanfilippo's using cancer center money as a “cash supply for the other less profitable hospitals…could begin to dry up the James's donor base.”

The article also noted that the cancer center advocates distrusted Dr. Sanfilippo because he had not been forthcoming about other medical center-related deals in the past.

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Made Sure Structure Did Not Include Oncology Dept.

According to Dr. Caligiuri, OSUCCC has more than 270 members from 13 of the university's 20 colleges, with more than a third of them residing outside the medical school.

He said he was very careful to make sure the new cancer center structure did not include a Department of Oncology.

“If I'd asked for an oncology department, then everyone from the outside would be looking in except for the members of that department,” he said. “I want to be able to take the resources of the James and plow them back into every department that has a cancer focus in this university—including the schools of business, engineering, social sciences, psychology, nursing, nutrition, pharmacy, veterinary medicine, medicine, dentistry, and agriculture.”

“They all receive money from the cancer center into their departments to develop a cancer focus, and there's nothing like money to make the world go round.”

He said that having a freestanding cancer hospital and all the resources dispersed across a large university campus will bring tremendous focus and alignment from everyone.

“We literally live through every department, and plow millions of dollars into those departments. I can't bring people onto the faculty without buy-in from the departments, so cooperation and collegiality is critical.”

“I really believe this is the best job in the country.”

© 2007 Lippincott Williams & Wilkins, Inc.
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