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State of the Department 2011
Jay L. Hess M.D. Ph.D. July 27, 2011
Overview
2
1. External environment
2. Department highlights - Clinical - Education - Research - Financial performance - Faculty 3. New building
4. Priorities
Overview
3
1. External environment
2. Department highlights - Clinical - Education - Research - Financial performance - Faculty 3. New building
4. Priorities
External environment – Federal, State and Region
4
1. National debt ($14.3 trillion)
- Reducing growth of Medicare costs
- Pressure on NIH spending
(try doing the Budget Puzzle: You Fix the Budget, NYT November 13, 2011)
2. Healthcare reform
- Return to capitated payment systems/bundled payments
- Increasing focus on paying for quality and outcomes
- Increasing focus on patient perception of care including Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
- UMHS has submitted Pioneer ACO letter of intent
External environment – Federal, State and Region
5
1. State
- Aging population
- $4 million reduction in Indirect Medical Education
- Gradual but steady decrease in commercial insurance
2. Region
- Corporate closures (Borders, ?Thomson Reuters) - Ann Arbor Public Schools (62.3 teaching FTE cut, reduced bus service, etc.)
Change in MI population 2000-2010
External environment – UMHS
6
1. Leadership: Dean and CEO reappointed for 5 year terms Search ongoing for CIO, CFO, Head of Development, three clinical chairs
2. UMHS: margin: 2.66% on revenues of $2.1 billion
A negative (-1.1%) margin is projected for FY12
Fiscal Year % $
FY02 1.00% $10.2M
FY03 2.10% $23.0M
FY04 4.10% $49.2M
FY05 5.40% $70.7M
FY06 5.52% $79.4M
FY07 3.90% $61.7M
FY08 1.30% $22.4M
FY09 1.00% $18.5M
FY10 3.20% $63.4M
FY11 2.66%* $55.9M*
Merit program
2.0% Staff3.0% Faculty
External Environment: UMMS Growth in NIH funding
Ran
k
Federal Fiscal Year
Mark
et
Sh
are
9
External Environment: North Campus Research Complex
Expenditures thus far are under projections
Overview
10
1. External environment
2. Department highlights - Clinical - Education - Research - Financial performance - Faculty 3. New building
4. Priorities
Clinical Highlights
2003 2004 2005 2006 2007 2008 2009 2010 2011$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
$12,000,000
$14,000,000
$16,000,000
$18,000,000
$8,532,919
$10,306,537
$11,331,000 $12,002,111 $11,974,304
$13,054,775 $13,924,576
$14,550,858
$16,046,236
$6,266,870
$7,648,963
$8,761,581 $9,245,472 $9,592,076
$10,306,828 $11,153,870
$11,610,733
$12,669,924
$2,266,049 $2,657,574 $2,569,419 $2,756,639
$2,382,228 $2,747,947 $2,770,706 $2,940,126
$3,376,312
Pathology Net Collections By Fiscal Year
Total CollectionsHealth SystemMlabs
Net
Collecti
ons
89,785 surgicals 11.3% increase over FY10Consults +23.6% Dermpath +23.0%Placenta +26.4%
Clinical Highlights: Keeping up with clinical demand
Pathology Revenue FY 2011Hospital Net Revenue Not Included
3707
3
3716
5
3725
7
3734
7
3743
8
3753
0
3762
2
3771
2
3780
3
3789
5
3798
7
3807
8
3816
9
3826
1
3835
3
3844
3
3853
4
3862
6
3871
8
3880
8
3889
9
3899
1
3908
3
3917
3
3927
0
3935
6
3945
5
3954
6
3963
0
3972
2
3981
4
3990
4
3999
5
4008
7
4017
9
4026
9
4036
0
4045
2
4054
4
4063
4
400
450
500
550
600
AP RVUs per Clinical FTE (12 month rolling average)
RV
Us/
FT
E/m
on
th
Clinical Highlights
13
New Clinical Faculty
Aleodar Andea M.D. dermatopathology (molecular dermatopathology) Michael Bachman M.D. Ph.D. microbiology (molecular microbiology) May Chan M.D. dermatopathology Amer Heider M.D. pediatric pathology Alexandra Hristov M.D. dermatopathology Julie Jorns M.D. Breast pathology David Keren M.D. clinical chemistry
(Associate Director Clinical Labs) Amir Lagstein M.D. GYN/pulmonary Scott Owens M.D. GI/surgical pathology Judy Pang M.D. Ph.D. breast/cytopathology
Molecular diagnostics
Janu
ary 2
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ch 20
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2002
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2003
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ary 2
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2004
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2004
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ber 2
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2005
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ary 2
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2007
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ber 2
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ber 2
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ary 2
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2008
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2008
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ber 2
008
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ber 2
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ary 2
009
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ch 20
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2009
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2009
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ber 2
009
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ber 2
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ary 2
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ch 20
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May
2010
July
2010
Septem
ber 2
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ber 2
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ary 2
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ch 20
11
May
2011
0
200
400
600
800
1000
1200
1400
1600
1800
0
1
2
3
4
5
6
7
8
9
10
Molecular Diagnostics LaboratorySpecimens Received and TAT
Jan 2002 - June 2011
Specimens received Linear (Specimens received)TAT (days) Linear (TAT (days))
Month/Year
# o
f S
pec
imen
s re
ceiv
ed
TA
T (
day
s)
New focus on reference lab work
Loss of Promedica
New MLabs leadership
Jeffrey L. Myers M.D.
A. James French Professor of Diagnostic Pathology
Director of Anatomic PathologyDirector of MLabs
2010 Dean’s Outstanding Clinician Award
MLabs
FY05 FY06 FY07 FY08 FY09 FY10 FY11$1,900,000
$2,100,000
$2,300,000
$2,500,000
$2,700,000
$2,900,000
$3,100,000
$3,300,000
$3,500,000
$3,700,000
$3,900,000
Total MLabs Hospital Margin
Hospital Margin
(Margin is split equally between Department and HHC)
Expansion of Forensic Services
17
Jeffrey Jentzen M.D. Autopsy and Forensic Services
A new perspective on the “Ideal patient Care Experience”
18
Service Excellence
Platnum Rule
“Treat others the way they would like to be treated”
Technical Excellence
Safety, quality and personalized diagnostics
- The right treatment - For the right patient - At the right time
Service Excellence
19
Pathology employee engagement survey: Room for improvement
Willingness to recommend work area 63.7%
We get the recognition we deserve 52.4%
Easy communicating information to higher 56.2% Levels of organization
My team had high employee motivation 57.1%
Service Excellence
20
S.E. Video & Facilitator
Guide
Curriculum Development
Prepare the Leader Phases
Staff Roll Out Phases
Measurement
Completion & Early Adopter
Phase
Consultation
April 2011 - April 2013
Future of Clinical Diagnostics: Personalized Medicine
21
1. What disease do I have?
2. Which drug(s) will it respond to?
3. How much drug should I take?
4. What are my risks of having an adverse drug reaction?
5. What’s my prognosis?
Increasingly the answers to these questions come from genomic information
Our field is changing rapidly- High throughput sequencing (HTS)
22Forbes June 3, 2010
Our focus: cancer diagnostics
• Molecularly-targeted oncology therapies are making a difference for patients
• High projected growth rate in new drugs and diagnostics
ELM4-ALK - lung cancer (ALK inhibitors) EGFR – lung cancer (gefitinib) BRAF – melanoma (BRAF/MEK inhibitors) HER2/neu – breast cancer (trastuzamab) c-KIT – GIST (imatinib) BCR-ABL- CML (imatinib, nilotinib)
• Has potential to reduce costs through more selective treatment
23
Outlook for cancer diagnostics
24
Nature Reviews Drug Discovery 8, 279-286, 2009
Outlook: The microeconomics of personalized medicine: today's challenge and tomorrow's promise. Jerel C. Davis, Laura Furstenthal, Amar A. Desai, Troy Norris, Saumya Sutaria, Edd Fleming & Philip Ma
Our strengths in sequencing-based cancer diagnostics
25
MLabs
Molecular
Diagnostics
Pathology Informatics
AP/HP
Consultation
Research and biomarker discovery
One of top two programs in pathology informatics
• Michigan Center for Translational Pathology• Top ten in NIH funding • 23.3% growth in NIH funding in FY11
14% growth in FY11 33% growth rate in FY11
Basic Research
Michigan Center for Translational Pathology (MCTP)
26
Mission
Establish the University of Michigan as the international leader in discovery and characterization of disease biomarkers and therapeutic targets using an integrated multi-disciplinary, systems biology approach.
Establish a new paradigm of bringing personalized medicine to routine clinical care through the use of high-throughput sequencing
Arul Chinnaiyan M.D. Ph.D. Director MCTP
Biomarker discovery in prostate cancer
27
ETS inhibitors/PARP inhibitors
SPINK1 mAb/ EGFR inhibitors
RAF/MEK inhibitors
50-60%
10-15%
1-2%
28
Presented at 2011 ASCO Meeting
HTS-based clinical diagnostic testing
Over 1000 cancer transcriptomes sequencedResults now reported back to patients as part of clinical trial
Oncoseq - High throughput sequencing software
29
Timeline from Tissue Biopsy to Sequencing Results
Tumor Biopsy
Sample Prep
Pathology Sequencing Analysis
Day 1 Day 2 Day 3-9 Day 10-18 Day 19-23
GeneALKBRAFEGFRERBB2PIK3CAPTEN
StatusWTV600EWTWTWTWT
CLIAPending
Day 23-30
Sequence Results
Timeline from Tissue Biopsy to Sequencing Results
No Patient Age Prior Therapies Sequence Results Potential Pathways for Therapeutic Intervention
Examples of Approved or Investigational Agents
1 Metastatic Castrate Resistant Prostate Cancer
67 Leuprolide + bicalutamideDiethylstilbestrolNY-ESO vaccine studyAzacytidine + valproic acid study
PTEN deletionAR amplificationT2:ERG
CPNE4-NEK11TP53 mutation
PI3K inhibitors
Androgen blockadeAndrogen SignalingPARP inhibitors
(NIMA kinases?)
BEZ235, GDC-0941, XL147
Abiraterone, MDV3100
Olaparib
??
2 Metastatic Prostate Cancer
61 Hormone Naïve (Newly diagnosed)
TP53 mutationPTEN deletionT2:ERG PLK1 outlier
PI3K inhibitorsAndrogen signalingPARP inhibitors (Umich trial)Polo kinase inhibitors
BEZ235, GDC-0941, XL147 Abiraterone, MDV3100 OlaparibBI2536, GSK461364A, ON-01910
3 Myelofibrosis 59 Hydroxyurea, Anagrelide, Lenalidomide, Cladribine
MPL 515 mutation Jak Inhibitors INCB018424
4 Metastatic Colorectal Cancer
46 FOLFOX + Cetuximab Irinotecan + Cetuximab Phase 1:TAK-901
N-ras mutation
CDK8 amplification
BRAF and MEK inhibitorsPI3K inhibitorsCDK inhibitors
PLX4032, GSK2118436, AZD6244BEZ235, GDC-0941, XL147Flavopiridol
5 Metastatic Melanoma
48 Multiple Resections H-ras mutation
CDKN2C inactivation
B-raf and MEK inhibitorsPIK3 inhibitorsCDK inhibitors
PLX4032, GSK2118436, AZD6244BEZ235, GDC-0941, XL147 Flavopiridol
Personalized Oncology Through Integrative Next Generation Sequencing
>60% tumorTumor Biopsy
Sequencing & Analysis
Buccal swab or
Blood(germline)
Target X
Target Y
Target Z
Discovery
Trial: X
Trial: Y
Trial: Z
Basic Research
33
Milestone 1: Provide information to consented patients who are requesting information (n>10 in waiting). Funded by MCTP and PCF. Goal is to profile >100 patients. (Year 1, 3-12 months)
Milestone 2: Introduce Ancillary Tests (including CTCs, urine T2-ERG, Michigan Prostate Panel (ERG, ETV1, SPINK1, RAF kinase, AMACR, p63). Funded by MCTP, Gen-Probe, Ventana/Roche, PCF (Year 1, 3-12 months)
Milestone 3: Develop protocols compatible with FFPE, small/degraded samples: (Year 1, month 6 onwards)
Milestone 4: Support clinical trials with high throughput sequencing. Funded by MCTP, PCF and/or drug company (Year 2 onwards)
Milestone 5: Offer as a test in CLIA/CAP reference lab setting (Year 3 onwards)
Molecular diagnostics milestones
34
Academic Medical Centers
For profit Reference
Labs
HTS Lab University of Michigan + corporate informatics partner
Business models for HTS-based diagnostics
• Vendor• Joint venture
Hospitals
• Vendor• Cotenancy
• Vendor
Education Highlights
35
1. Educational office reorganization
2. Strong performance in match
3. New fellowships in - Pediatric Pathology - Forensic Pathology - HLA (pending) - Chemistry and Microbiology (future)
4. Clinical Scholars Program
5. Management training and personalized medicine
6. Reorganization of VA rotations (thank you Dr. Chensue)
Professorships: Godfrey Stobbe Professor of Pathology Education
Investiture August 12, 2011
Alumni Center
Research Highlights
37
New Faculty
Michael Bachman M.D. Ph.D. bacterial pathogenesis molecular microbiology
Maria “Ken” Figueroa M.D. epigenetics of MDS and leukemia
Jeff Rual Ph.D. high throughput proteomics
Research: Department external funding
Pathology Revenue FY 2011Hospital Net Revenue Not Included
FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011$0
$10,000,000
$20,000,000
$30,000,000
$40,000,000
$50,000,000
$60,000,000
$17,
126,
967
$21,
916,
142
$20,
480,
632
$21,
260,
912
$24,
829,
140
$25,
669,
434
$21,
700,
067
$26,
757,
065
$25,
411,
779
$18,
603,
863
$23,
426,
716
$26,
266,
958
$24,
552,
395
$22,
921,
424
$59,
488,
720
$31,
908,
076
Committed Total Awards and Submitted Initial Budget Period Totals by Fiscal Year
Committed Submitted
Fiscal Year
Do
llar
s ($
)
23.3% increase over FY10 IDC $150/sq ft Benchmark $110/sq ft
Research administration
39
Medical School Faculty Satisfaction Survey-Pathology
2006 2008 2010
54.8 61.3 85.7
Professorships: Henry C. Bryant Professor of Pathology
Lymphoma Research Foundation Featured Researcher
American Society for Clinical Investigation
Investiture September 15, 2011 BSRB
Department Finances
Major changes affecting our finances:
1. NCRC ($9.5 million over 10 years) 2. Transition to RVU-based payment system 3. Revised Medical School Funds flow model (FAMIII)
What we have done to improve our finances:
4. Implemented professional component billing5. Renegotiated Professional Services Agreement (Part A)3. Revised MLabs agreement 4. Expanded MLabs business5. Submitted and secured more grants
Department Finances
2005 2006 2007 2008 2009 2010 2011$0.0
$20.0
$40.0
$60.0
$80.0
$100.0
$120.0
Department of Pathology Net Assets $ (Mil-lions)
UnrestrictedRestrictedTotals
Total margin before market changes $7,270,253Change in net assets with market changes $21,144,892
Gerald D. Abrams Endowment
Promotions
44
Colin Duckett Ph.D. ProfessorJason Gestwicki Ph.D. Associate Professor Celina Kleer Ph.D. Professor Richard Lieberman Ph.D. Associate ProfessorMegan Lim M.D. Ph.D. ProfessorPeter Lucas Ph.D. Associate Professor
Farewell
David Gordon M.D.
Next Dean of the University of Michigan Flint School of Health Professions and Studies
Reception August 3, 2011 Towsley Lobby
Farewell
Will G. Finn M.D.
Next Medical Director of Warde Medical Laboratory
Reception T.B.A.
New building
47
1. External environment
2. Department highlights - Clinical - Education - Research - Financial performance - Faculty 3. New building
4. Priorities
New building
200,000 gsf clinical laboratoriesAutomated core lab Up to 200,000 gsf faculty offices
Programming nowConceptual and schematic design 9/2011-11/2011Design development 12/2011-2/2012Construction document 3/2012- 9/2012 Bid and award 10/2012-12/2012Construction 1/2013-7/2016Activation 8/2016-9/2016Move in 10/2016
New building
New building
New building
New building
Overview
53
1. External environment
2. Department highlights - Clinical - Education - Research - Financial performance - Faculty 3. New building
4. Priorities
Priorities
Pathology Revenue FY 2011Hospital Net Revenue Not Included
Continually improve patient quality and safety Build state of the art new clinical laboratories
Replace Laboratory Information System (LIS) Establish Michigan as a leader in:
- pathology consultation - pathology informatics - biomarker discovery - bringing next generation sequencing into clinical use
Priorities
Pathology Revenue FY 2011Hospital Net Revenue Not Included
Develop new programs in epigenetics and chemical biology
Strengthen existing research programs in inflammation and aging
7. Strengthen research infrastructure and grants administration
8. Expand MLabs scope and profitability
Ensure the financial health of the Department
Ensure the Department is a place where careers of faculty and staff can thrive
Questions?