I'm Dr. Laurie Glimcher, dean of Weill Cornell Medical College, and today I am speaking with Dr. Michael Stewart, who's just been appointed vice dean of Weill Cornell Medical College. We are facing watershed moments in our country's health care system. Dr. Stewart, with his expertise, is going to help ensure that we not only stay ahead of the curve, but also lead the way.
LAURIE H. GLIMCHER: Mickey, it's a pleasure speaking with you.
MICHAEL STEWART: Thank you for the opportunity.
GLIMCHER: Well, the big news, of course, is the U.S. Supreme Court's decision upholding the Affordable Care Act. How does this law affect the Medical College's clinical activities?
STEWART: There's many different aspects of what was upheld and what was actually already in place. One of the main things that happened was that the new act is going to mandate that people will have insurance. So the uninsured will have insurance, Medicaid [coverage] will be expanded, Medicare will be expanded, and there will be new health insurance exchanges which allow people to buy insurance at more affordable rates. At our center, we actually have a huge number of patients who are already insured.
GLIMCHER: How does this change the way we teach and train the next generation of physicians and scientists, who are going to be responsible for the health care of this country?
STEWART: I think we need to do a better job of actually educating our medical students and residents and fellow trainees about the implications of population health and the implications of health care system delivery. And that's not just because of the Affordable Care Act. Care has been so individual: you see an individual doctor who does the best they can do for you. But now, with an increased emphasis on systems of care, continuity of care, following clinical pathways, using electronic health records, tracking health, screening, all these sorts of things, it really becomes very important how you interface with your system and how your patient gets integrated with your system and how you communicate with other physicians. I think we're going to be doing a better job of training physicians about some of these issues related to systems of care and patterns of care and caring for a population that you're responsible for, not just the patient who happens to show up that day.
GLIMCHER: This reform is certainly triggering sweeping changes in health care. What do we, here at Weill Cornell, need to do to ready us for this transition?
STEWART: We are really working very hard on this and have been for some time. The Physician Organization here [at] the Medical College has been forward-thinking. So, for example, having an electronic health record. We've had electronic health records here for many years. We're actually upgrading it now to an even better registration and scheduling system that will integrate with the record.
GLIMCHER: It's expected that payment schedules will change due to health care reform. What do you think this is going to mean for our future?
STEWART: I think, actually, we're going to always be somewhat of a hybrid because we're going to be a center that provides very, very specialized, what's called tertiary or quaternary care, so things like organ transplants, and highly sophisticated cancer resections and reconstructions, and so on. That the sort of thing that's pretty much, probably even in a very evolved model, always going to be paid on a per-case basis, so we're going to need to be prepared to provide that extra level of care. But for a lot of populations of patients, we're also going to be given population-based payments and bundled payments, not for each doctor visit, but to take care of a group of patients over a period of time. That's a different way of reimbursement. Now, some community-based practices will probably go to an almost entirely population or bundled model. I think our center, as big and complicated as it is, will probably have a lot of both, will probably have a lot of episodic, specialty and sub-specialty care and bundled care, and we have to be prepared to work in both of those systems.
GLIMCHER: Here at Weill Cornell Medical College, we have a tripartite mission of biomedical research, medical student education and graduate student education and clinical care. The patient is the center of our universe. Our mission is to provide the very best patient care we can, and that means both clinical care and discovery. What do you think these changes in health care are going to mean for the clinical enterprise at Weill Cornell?
STEWART: As you pointed out, patients are the center for so many reasons. We have to have clinical patients to be able to train the next generation of physicians. You have to have patients to be able to do research. Clinical care generates revenue that helps pay for other missions of the institution. In addition to that, you actually need clinicians who are seeing patients and identifying diseases because they identify questions that researchers can then explore.
GLIMCHER: So it's not just bench to bedside; it's bedside to bench.
It's always fun for me to hear people's stories. What was it like growing up for you? When did you get your first inkling that you wanted to be a doctor?
STEWART: I grew up in Louisville, Kentucky. There were no physicians directly in my family at all. But for some reason I just always kind of knew I wanted to be a doctor. In fact, I can remember my parents telling me that I used to practice scribbling my name over and over and they said, 'What are you doing?' and I said, 'Well, I'm practicing signing my prescriptions for when I'm a doctor.' [Glimcher laughs] And, of course, now we do it all electronically, so you never sign anything anymore.
GLIMCHER: What drew you to academic medicine?
STEWART: I went to Vanderbilt and then to Johns Hopkins, and I was around some really outstanding academic physicians. They really were role models and I saw that model of care and I thought I really, really wanted to be a part of that. Then I went to a very strong residency training program at Baylor College of Medicine in Houston where I had a very similar experience. I was exposed to very, very good mentors and very, very good people that made me want to follow in their footsteps. That is what got it started for me.
GLIMCHER: You've been here for seven years as an ear, nose and throat clinician. You're chair of a department, otolaryngology. You are an expert in public health. More recently, you've been a senior associate dean for clinical affairs. Is there something particularly appealing to you about Weill Cornell?
STEWART: This is a very collegial institution. Inevitably there is some competition and conflict, but this place is remarkable for how often we pull together. We actually look for opportunities to work together and collaborate. It's also a very dynamic place. There's very exciting things happening. Since I've been here, we've moved our entire department into a brand new, spectacular building, the Weill Greenberg Center. We're now building a brand new, spectacular research building. NewYork-Presbyterian Hospital is doing better than it's ever done. We've recruited a tremendous number of great faculty and some excellent chairs. And, of course, we have a dynamic new dean as well [Glimcher laughs]. So there's a lot of positive momentum and a lot of positive things happening.
GLIMCHER: Now you have a new position, vice dean of the Medical College. How do you think the experiences you've had in these other positions will bear on this new position?
STEWART: As chair of a clinical department, the most important thing we do is run a clinical enterprise. That's our primary mission and, of course, we train residents and students. My specialty in particular is quite interesting because we take care of adults and kids, we provide medical care and surgical care, we provide hospital care and outpatient care. So, actually, I'm fairly conversant with pretty much every other department and what they do. We're not a very, very limited field, which is nice. In my clinical research area, I've always done patient-based outcomes and public health type of research, so I understand population health. And I also serve as a journal editor, so I understand research and academic publication, and so on. So I think the combination of our clinical department and my particular specialty and my academic background has prepared me well to help the college in this new role.
GLIMCHER: Are there any projects that you are shepherding that are on the horizon now that relate to how we are going to have to change to adapt to the changes in emerging health care industry?
STEWART: I work very closely with Dr. Dan Knowles, who is the chief medical officer of the physician organization and the chairman of the Department of Pathology, to make sure that our clinical enterprise is adapting to this changing environment. For example, we are, as I mentioned earlier, already updating our electronic medical record and our clinical practice management system, and we're working with the hospital on a bundled payment application. The project I am working a lot on right now is the development of a network. So we are going to develop a network of employed physicians, primarily office-based, which is going to both increase our geographic presence across the city and the region, but it's also going to give us a base of office-based primary care that our specialists can refer to and receive referrals from, so that as we need to be able to provide continuous integrated care for a population, we'll have that primary base which currently at our very specialized center we don't have as broadly as we need.
GLIMCHER: Mickey, I have one final question for you [Stewart laughs]. Do you always wear cowboy boots?
STEWART: Well, I actually do. I wear cowboy boots more in New York City than I did when I was in Houston. But I learned to love them when I was in Houston, and now when I wear them in New York, my patients and colleagues often ask me about them and if I don't wear them they fuss. They say, 'Where are your boots?' So yes, I wear boots all the time, and I like them [Glimcher and Stewart laugh].
GLIMCHER: Well, thank you, Mickey. I really appreciate you taking the time to speak with me, and I'm absolutely confident that with your leadership, Weill Cornell is headed for great things in the future. I am delighted to have you on board.
STEWART: Thank you very much.