Michael J. Oinonen

To investigate whether there is a misalignment of the perceived values of and incentives for clinical research within U.S. academic health centers (AHCs), in 1999 the authors surveyed medical school deans, academic administrators, department chairs, and faculty members at 80 AHCs that are the members of the University HealthSystem Consortium, a not-for-profit consortium of AHCs. A total of 358 faculty from 58% of the institutions surveyed responded, with a mean of 3.76 responses/institution. There was general agreement that clinical research offers AHCs a considerable spectrum of benefits, including prestige, recruitment and retention of faculty, criteria for promotion of faculty, and financial support. Investigator-initiated research and government-funded research ranked highest in terms of their desirability compared with industry-sponsored and contract research. This preference was agreed upon across all categories of respondents and types of research (translational, clinical tests, and outcomes). Significant differences existed between the perceptions of deans/AHC administrators, who stated that they were increasing their emphasis on clinical investigation in the areas of research space (56% of responders), administrative support (81%), and patient recruitment (61%) and the perceptions of their departmental chairs/faculties in the same areas (34%, 52%, and 40%, respectively; p < .05). Faculty opinions documented few new investments in the actual infrastructure dedicated to clinical research. The authors conclude that their findings, which they consider reasonably representative, strongly suggest that the value of clinical research to AHCs is well understood. Their findings also identify important opportunities for AHCs to provide a wider range of incentives for the conduct of clinical research.

This study audited the efficiency and accuracy of patient billing and reimbursement systems for epoetin alfa (Epo). The outpatient records of 604 chronic dialysis patients at eight academic health centers, from selected quarters during 1989 to 1993, were reviewed. The number of units administered or dispensed for home use was compared with Health Care Finance Administration (HCFA) reimbursement records. Overall, 18% (range 2% to 45% per institution) of the Epo administered or dispensed at the study sites was not represented in the HCFA reimbursement records. Institutions may be losing some entitled reimbursement for Epo and should evaluate their reporting/billing practices. The extent to which reimbursement for Epo, our test drug, reflects billing/reimbursement inefficiencies for other drugs deserves further evaluation.