LAUSR

Academic medical centers are expanding services in community locations [1, 2], thereby improving patient access to care in new geographic regions and reducing disparity of care by offering subspecialty services to historically underserved populations. While the recent expansion of adult academic medical centers into community locations has been described, including community expansion models focused on academic radiology [3–8], there has not been a similar focus on the developing community–academic partnerships in the pediatric sphere. The academic medical center tripartite mission of education, clinical care and research is expensive, costing 10–20% more than non-academic medical centers on a case-mix adjusted basis [9, 10]. Additionally, academic medical centers have been disproportionately affected economically by health care reform initiatives in the United States designed to improve quality through reduced payments to low-performing hospitals that may not adequately risk-adjust for differences in case mix, patient comorbidities and patient sociodemographic characteristics [2, 9, 11]. The prior academic model was financially sustainable in part because of external research grant funding, governmental and institutional subsidies, philanthropic donations, lower salaries relative to private practice, and favorable reimbursements [2]. Compared to the 1980s, when clinical services represented only 20% of academic medical center revenues, currently they account for nearly 80% of total revenues [1]. In response to these economic pressures, academic centers are expanding into the community in a variety of ways— via merger, acquisition, partnerships with existing community health systems, or by a “brick-and-mortar” approach in which they physically expand to new locations [1, 2]. These models vary by amount of up-front capital investment, time to profitability, and need to develop referral relationships and brand impact via their ability to control and integrate employees, resources, processes and culture. Economies of scale can be attained by serving a larger patient population without a full capital investment in the community location, which decreases cost per procedure, and by channeling patients from the community to the main academic center who require advanced levels of care, which improves asset utilization and productivity [2]. Pediatric academic health systems, facing the same economic pressures, are increasingly developing a community strategy. Here, we discuss the opportunities and challenges experienced over the last decade in creating a pediatric academic–community radiology practice within a large pediatric academic health system.