07.09.15: COM Research Council Meeting Attendees: Sean Adams, John Arthur, Charlotte Hobbs, Clint Kilts, Stavros Manolagas, Phil Mayeux, Michael Owens, Mark Smeltzer, Alan Tackett, Roxane Townsend, Richard Turnage, Henry Wong Absent: Nancy Gray, Michael Jennings, Rick Owen, Jeanne Wei ACTION ITEMS  

Everybody on council needs to thoughtfully consider possible mechanisms for Clinical Scientist Development Award (1% of capital funds, >$2 million) to stimulate research on campus as well as appropriate forum for announcement. Possibly change name of Clinical Program Development Award

PRIMARY AGENDA ITEMS   

Addressing concerns of research community regarding clinical service lines Explanation of Funds Flow from Clinical Service Lines and how research will be supported New task for Dr. Hobbs and Research Council: recommend mechanism for 1% of CSL revenue earmarked for research

FUTURE CONSIDERATIONS:    

Faculty access to their own indirects Formulating formal research agenda for UAMS College of Medicine Look into development officer for the university to maximize our investments, capitalize on target programs Research Capital Campaign Discussion with Pope Moseley

Meeting Minutes:

I.

Introductions of Research Council to COM Dean (Turnage) and MC CEO (Townsend) A. Research Council expressed appreciation to Dean and CEO for coming to explain and discuss how the new clinical service lines will support and affect research (Hobbs).

II.

Research Council Members Concerns regarding CSL effects on research were expressed A. Manolagas: Investigators who are losing their research fundingthe school still has obligations to pay their salaries from where do these funds come? 1. Turnage: so long as these people are written into the budget for this year, their salaries are guaranteed regardless of how successful they are at securing funding. a. The amount of salary they receive will be dependent on their potential as researchers as determined by the Chair of their departmentif good potential, whole salary. b. This process of writing into the budget and determining salary level is based on department chair’s recommendation. c. If what is happening is not reasonable (70% of time allocated to research, but not submitting grants), there will be a conversation between the chair, individual and the dean of college, and they may lose their salary. d. On the other hand if what is happening is reasonable (unsuccessful submissions, but still publishing and a good citizen), salary will be retained. 2. Turnage: Ultimately, this is a balance and some hard decisions are made a. Perhaps this group could play a role in those decisions and help decide when a faculty member should rethink their research approach. 3. Townsend: As far as who is responsible for the tenure obligation, that is NOT the med center clinical enterprise—that is the College of Medicine a. Those costs are not directly related to the clinical service lines b. The clinical enterprise funds “service line functions”—other expense is the COM

c. 4. Turnage: “Clinical Trials Research” is the softest (least defined) of these categories a. Dr. Turnage (cannot speak for Dr. Townsend or others) thinks that many types of translational research (not just clinical trials) are inseperable from the bedside b. He would love to see that broadened to include other types of research which are intimately associated with patient care (healthcare delivery research and truly high-quality, closely translational research should be included here) i. However there are others involved in this decision (Chancellor and CEO) and this is not necessarily how it is going to be. c. Clinical trials are what is crystal clear how that applies to patient care. B. Arthur: There is a lot of angst on campus regarding CSL switch and he is involved directly in it there are some faculty from IM department who are not on budget for the next year and who are in between funding (one has been close to continuously funded since 1990)  the departmental funding to support these people while they are not funded has been siphoned off to CSL—how do we retain these promising investigators? If this had happened before CSL, we would have been able to allocate some money from clinical trials or clinical revenue, but that is all gone now because the department is unable to carry over margins from previous year. 1. Turnage: these people should not be written out of the budget. He cannot recall this being the case, but he will check with Dr. Marsh and look into it further. 2. Arthur: Clinical trials used to be something that you do so that you could generate money for the department to buy a new gel chromatographer (or other equipment) – Is this gone now? a. It is unknown how we will reward entrepreneurship in the new model. b. This is one of the reasons that the Dean’s Tax was retained though so that there is money that will be available to to the departments and divisions. C. Smeltzer: Basic scientists do not have access to any clinical revenue stream. The last few years have been a horrible funding environment. How will we keep basic science researchers active, engaged, see them through? It is like investing in the stock market when it is down it is good strategy. Where is the pool of money to invest in basic scientists? 1. Turnage: There will not be wholesale groups of people excluded from research funding revenue of clinical service lines. This group will help decide how basic scientists will fit it a. A requirement is that the research be high quality good return on investment 2. Goal is to improve the research environment for both clinical and basic researchers. 3. Townsend: research is a priority for UAMS, but we have not acted that way a. There was a question of whether or not to continue taxes on professional roles (Deans tax, etc.) to help fund the College of Medicine, and we decided to keep the deans taxwe believe this too will help support the research mission b. If by doing the service line model well, efficiently, we will have a bigger bottom line and be able to invest more in research. D. Smeltzer: Why is it that researchers do not have access to their indirects? They do at other institutions. 1. At COPH, COP and ACHRI, some portion of the indirects go back to the investigator 2. Indirects is something that will keep coming up—I (Smeltzer) have been funded since 1996, but think about the amount of indirects he would have made if even a tiny portion had been returned to him I have had to let people go, morale is down

3. We MUST find a way to provide basic scientists with a mechanism to keep productive labs running through rough times. Money from the clinical revenue stream would be a remarkable and much needed boost to morale among basic scientists, but I personally think the return of some portion of IDCs is equally important.

III.

Overview of Medical Center Enterprise Revenue (Townsend) A. The hospital receives absolutely no state funding all state funds come to the Colleges 1. Hospital has to eat what it kills In addition to having to generate its own revenue, it covers many expenses a. $35 million in overhead to the campus; $48 million to DHS and Medicaid $13 mil to cover resident salaries; another $__ million to support faculty lines b. This year, there will be a 1.5% profit margin about $10million i. This money will get swept to campus to support education, research and clinical programs ii. The minimum amount that they really needed was $12 million iii. At end of year, there is no money in reserve that belongs to the hospital c. There are over $600 million in revenue, but this amount covers a lot of expenses d. 75% of institutional revenue comes from the clinical enterprise i. 6% from the state, 3% from tuition, 12-13% from grants B. What is expected is that the enterprise (clinical service lines) contributes positively to the mission 1. If a person is designating time to do research, success is expected to come from the grants that they bring in. This activity/these determinations reside at the level of COM C. Turnage: In the past, professional revenue has been split up into individual departments this was all superficial though as it all was UAMS funds flow D. Turnage: Now the clinical revenue will be put into one pot (hospital, practices, etc.)—Funds flow slide

1. 2. Subtracted from the pot first are clinical operating expenses, salaries of all the people who work at hospital, etc. 3. Also taken off the top, $1.2 mil for Clinician Scientist Program and 15% of revenue to the Clinical Program Development (research) award a. Historically, the university has invested in research exclusively from the margin this is taken off the top and shows the university’s commitment to research b. In the past, the 1% of the professional revenue had been used to hire new clinicians, who had to show positive margins within 2-3 years of hire this excluded faculty interested in doing research c. Dr. Townsend has opened up this 1% to be used to support researchers whose work applies to clinical programs serious amount of money (>$2million) d. It is our responsibility make sure that the research to be funded is of high enough quality to show a return on investment, be very very good e. We would like research council to assist in coming up with a mechanism for judicating the award What research is this money going to fund? 4. Another possible source of research funding from clinical service lines is the “Service Line Investments” from the operating margin or “Strategic Investments” a. Strategic research investments could be a part of thisChancellor decides b. Pragmatically, the only way that you can spin off a margin is by doing clinical care better than they have been doing it for the past 5-6 years i. CSL are experiment to provide better care, more efficiently

E.

IV.

ii. If margin grows, research will benefit. 5. So within the CSL model, there are 5 possible sources of Research funding a. Clinician Scientist Award, Clinical Program Development Award, Support from the College of Medicine, Strategic Investments and Service Line Investments b. 3 of 5 are off the top (not dependent on margin) Manolagas: what is the projected growth expected from the clinical service lines model 1. Townsend: our ability to grow larger patient base is fairly landlocked in that the hospital is often at 90% occupancy and outpatient clinic visits have grown 15%.  our growth on current chassis is limited a. By cutting down inefficiencies, we project to increase 10-15%, which is very significant when you consider the revenue is about 800-900 million.

Drs. Turnage and Townsend would like COM Exec Assoc Dean for Research (Hobbs) to help inform and make recommendations for how revenue from clinical service lines can best support research. A. Dr. Hobbs, with the assistance of the COM Research Council, is to assist the COM Dean and Med Center CEO in proposing a mechanism to use this 1% Clinical Program Development Fund to stimulate research on campus. B. Recommendations will go back to the Dean and CEO for approval. 1. Turnage: these are precious dollars, so that quality of research must be deserving of them. 2. Must resonate with the research facultypeople’s definitions of high quality vary by individual. 3. The Research Council is the keeper of the definition we have responsibility a. The temptation exists to use dollars to fund a line of research that is just not going to be successful a chair looking for any way to make their margin i. This is NOT what we want to do. C. Smeltzer: If the clinical enterprise is the source of funds, is it also the destination or is research the destination? 1. The name “Clinical Program Development Fund” is deceptive, misnomer in that it does not seem to have anything to do with research, especially basic research. a. Cannot just show the funds flow slide without explaining it discourages. 2. Hobbs: the research must be translational, but this does not mean that it cannot be basic a. For instance, if I am wanting to study sepsis in the neonate, the first clinically translatable step may be to study endothelium in an animal model b. We need to include COM Dean and CEO in our discussion so that we can get feedback on which ideas are too far removed from clinical care 3. Turnage: the pool could also possibly be slpit some dollars for healthcare delivery research, some for more basic question, some for clinical initiatives a. These are new dollars that are taken off the top (protected expense) and we, as an institution, have not be able to access for research until now b. These dollars are not just for the MD clinician scientist—there may be a PhD—especially if that PhD is functioning as part of a team. D. Question brought up about whether this would be bridge funding 1. Townsend: Not really this is up front support for research bridge funding is a different piece, usually from the College 2. Turnage: We get to dream this up if I were having discussion with Pope and Roxane, perhaps bridge funding would be a part of that but it really needs to be used well a. In the basic science departments, individuals already have mechanisms that will sync a person’s salary as they lose their funding. E. Manolagas: What, in one minute, is your view of why we are wanting to invest these funds? 1. Turnage: we are a research university and we don’t do a whole lost to support research internally I think that we need to see researchers who need to be given support to get the ball rolling on their projects I don’t think that we currently do that very wellI also think it is the right thing to do what has happened over the last 5-7 years to science at UAMS has been ugly this is an opportunity to begin to correct it. F. Description of the type of mechanism they are looking for (Turnage) 1. Qualities that are important to institution 2. Programs that cut across various departments or even colleges or campuses (ACH & UAMS). 3. Team-based, research involving both basic and clinical scientists across various specialities 4. Manolagas: maximization of talent

V.

The Clinical Service Lines support for Research is a great message for discouraged researchers on campus (Tackett) A. Arthur: I would like to see mechanisms 1. Hobbs: that is our task now as research council it is exciting that we have the opportunity to advise on this, it should not reside in just one person a. It is our job to put our minds, as successful researchers, to this task B. Kilts: It is refreshing to hear the words research and investment in the same sentence

1. What is the valuation of research on campus is it just $$$? a. Research loses money, and it should lose money the metric of success is something other than just money the returns are both tangibles and intangibles i. Hobbs: some researchers can bring more money to the university by getting involved in research versus working full time clinical I know this from experience ii. Manolagas: I am more optimistic, and I think this is a very clever plan that will not lose money. I have come from institutions where researchers made a ton of money in indirects. This does not need to be a losing proposition. b. I hope it will benefit researchers in clinical departments who up to know have had no incentive (and even reasons not ) to continue research i. Find a way to incentivize research in clinical departments. ii. Turnage: clinician scientists are an endangered species this is why Roxane provided the funding for this program to replenish that resource. 2. The future in the next 12 months is looking better than it had. C. Hobbs: Perhaps we should think about how we move forward before making a major announcement 1. It has already been announced during faculty meetings, but it may not really have been received and understood 2. We should figure out the right timing and be wary about announcements with no details 3. For what researchers on this campus have been going through, it seems awfully good. 4. We do not want further loss of excellent researchers this may be a reason to announce earlier over the next few weeks we will think of how to provide message which forum a. Need to turn culture around 5. Tackett: Should try to coincide announcement with arrival of new dean people are optimistic and this would be a double whammy and raise morale timing is critical. D. Smeltzer: the basic scientists would be excited that clinical revenue would be able to trickle down for use of basic scientists. 1. The perception among basic scientists on campus is the CSL model is leaving them in the dust. E. Townsend: this will be a little over $2 million 1. Manolagas: Why not go to Walmart and say, “can you match this?” a. Townsend: Walmart has not been forthcoming about philanthropy with UAMS b. We would need an exciting plan that is totally convincing and show successes 2. Is there a formal research agenda for UAMS? a. Hobbs: there is only some language in the 5 year strategic plan about research, but not a true agenda b. There are many opportunities for philanthropy, but we need to have a story to tell. 3. We should think about hiring a developer with the cooperation of the College of Medicine Administration F. Tackett: It is finally starting to feel as though we are turning a page and this is evidence of that 1. The researchers are really looking toward the hiring of Pope Moseley as a new opportunity 2. Turnage: Research has been a part of his life and this was thought a huge advantage to him G. Manolagas: Research grows the visibility of the university 1. 20 years ago, UAMS was an exciting place to be people from all over the country were looking for positions here. H. Research Capital Campaign (Kilts) 1. There are some prime targets to use here: child well-being, violence, etc. that UAMS does well 2. Need to discuss this idea with Pope Moseley

VI.

Other things to Consider A. Smeltzer: This council is now dealing with large problems, but there are some small ones that need to be addressed 1. Example: Danielle Atwood is leaving the university (MD/PhD student going back to medical school—they are badgering her to give in her student ID card—need to change things like this 2. It should not be a difficult process to allow a PhD student to continue her lab privileges as she returns to medical school. 3. This issue should be addressed as it happens each time a PhD student successfully defends their dissertation and wants to stay in the same lab for some time.

VII.

Brief Discussion on Centralization A. Hobbs: This will be an option for departments if they already have a strong research administrative group established, they will not be required to work with central group B. Hobbs: This is also just at the stage of a proposal which will be presented to the Chancellor in Jan 2016.

VIII.

Brief Discussion of Inclusion of Early-Career Investigators in Clinician Scientist Program events A. This should be decided on a case by case basis B. Sarah Mulkey is deserving of this, and the program has enough resources at this time.

IX.

Research Council Mission Statement A. Many did not receive—will resend B. Will hold off on vote until new dean established

X.

Future meetings A. Doodle poll to establish meeting within the next 3 weeks.