Johns Hopkins Magazine -- February 1997
Johns Hopkins Magazine


O N    C A M P U S E S

Hopkins Medicine gets new "czar"... pedagogy goes high-tech... Davidsen named interim dean of faculty... is there a Medicare audit on the horizon?... creative approaches to funding... Peterson appointed hospital president... Hopkins Press puts journals on-line... life after the bronze

Medicine "czar" named
As Johns Hopkins Medicine looks outward at the challenges facing academic medical centers, it has turned inward for the person who will lead it through those challenges and into the 21st century.

Edward D. Miller Jr., the highly regarded interim dean of the faculty of the School of Medicine, has been named the first chief executive officer of Johns Hopkins Medicine and the 13th dean of the medical school. His selection came after a nearly one-year national search to find the person to coordinate the tripartite mission of research, teaching, and patient care and serve as its spokesperson. Miller, 53, assumed his new position on January 17.

Miller arrived at Hopkins in 1994 as director of Anesthesiology and Critical Care Medicine. He came from Columbia University, where he had been Anesthesiology chair for eight years. For 11 years before that, he served as president of the clinical faculty at the University of Virginia. A graduate of University of Rochester Medical School, he is an expert on anesthetic drugs. He has authored or co-authored more than 150 scientific papers, abstracts, and textbook chapters and received numerous NIH peer-reviewed grants.

"Dr. Miller brings to the table a sense of understanding of the clinical dimension," said Ronald R. Peterson, the recently named president of Johns Hopkins Hospital and acting president of the Johns Hopkins Health System who, under the new structure, will report to Miller. "He also understands the importance of research and the way in which that mission ties to the teaching and [patient care] missions. His sensitivity and understanding of these interrelationships are terribly important as the hospital deals with some very difficult issues."

Miller was selected by a 17-member search committee that considered several hundred potential and actual applicants.

"I was pretty certain we would go outside for this appointment," said Edward K. Dunn Jr., Hopkins Medicine trustee and search committee chairman. "As we conducted our search, the troika of leadership of President Brody, Ron Peterson, and Ed Miller was very, very effective. We saw that they were not just holding the fort together until fresh troops arrived. Particularly at the urging of Ed as interim dean, they were taking on substantive challenges in areas that were delicate and important to all involved.

Said Miller, "Now there is someone to speak with one voice, to articulate the joint mission of Johns Hopkins Medicine." -- Steve Libowitz

Toward high-tech teaching
Grants sometimes are described as "seed money." At a recent Hopkins symposium, the audience got a look at some high-tech educational work done with SEDE money.

The symposium, titled "The Writing is On the Monitor," showcased nine projects from a variety of disciplines. All were awarded grants through SEDE (the Subcommittee on Electronic and Distance Education), which parceled out $42,000 in funding from the Provost's Office. SEDE's objective: to encourage faculty to rethink their curricula to take advantage of high-tech resources.

And rethink they did. At the Peabody Prep, violin instructors Dorothy Blankenship-Baldwin and Philip Baldwin are at work on a CD-ROM that, when completed, will help Suzuki violin students practice at home. Pint-sized violinists concerned about bow technique, for example, can watch, listen, and imitate a musician on their computer monitor.

For older students of a scientific bent, Michael Karweit demonstrated a CD-ROM he's created for solving heat transfer problems. One thing it lets students do is create logic circuits on a computer as they experiment to answer a problem; they then test their circuits by computer simulation, to see if their answer works. The technology allows for more than one solution as students find their way by trial and error. "Problems in textbooks have a single correct answer," explained the research professor of chemical engineering. "Life problems are more likely to be ambiguous. The point is to teach students that the world is complicated."

Accessibility is the issue Harry Sieber faced in putting together his new Web site devoted to the imagery found in early editions of Cervantes's Don Quixote. The professor of Hispanic and Italian studies digitized images found in antique volumes in the Peabody Library--images that are rare, not easily located, difficult to access, and rarely put on display because they are so fragile.

The presenters discussed the difficulties they encountered in their development efforts. They spoke almost as one about how much they had underestimated the time needed to digitize images, secure permission to reproduce copyrighted material, and write programs. But all were enthusiastic about the potential for high-tech pedagogy. --DK

Davidsen named interim dean of faculty
Arthur Davidsen, the man who led Hopkins's ventures into space with the Hopkins Ultraviolet Telescope, has been tapped to serve as interim dean of the faculty of the Krieger School of Arts and Sciences.

Davidsen will serve under dean Steven Knapp, who was named provost of the university earlier this year. Knapp said that Davidsen will concentrate on the internal affairs of the school, while he will continue to lead the school's fundraising efforts in the Johns Hopkins Initiative, manage its relations with other university divisions, and focus on his duties as provost--which include searching for his replacement as permanent dean.

Davidsen has served on the Hopkins faculty for more than 20 years, and recently completed a five-year term on the Homewood Academic Council. The astrophysicist said he will continue his research while serving as interim dean of the faculty. Will he be a candidate for the permanent deanship? "I'll cross that bridge when and if I come to it," Davidsen said.

Hopkins contacted by Medicare auditors
The U.S. Department of Health and Human Services (HHS) appears ready to conduct an audit of Medicare billing practices by Hopkins faculty physicians, as part of a nationwide review of Medicare billing at teaching hospitals.

In November, the dean's office of the School of Medicine was asked to submit background information to assist HHS in an audit of Medicare billing procedures. Although HHS did not state that an audit was a certainty, Hopkins officials are fully expecting one. As of mid-December, no date had been set for an on-site audit.

More than two dozen academic medical centers were likewise informed of HHS audits. In December 1995, the University of Pennsylvania paid a $30 million settlement, following an audit of its Medicare billing.

Medicare, the government's health insurance plan for senior citizens, accounts for 27 percent of gross charges for the Hopkins clinical practice association, says Edward Miller, CEO of Medicine and medical school dean.

University officials stress that the audit does not relate to the quality of patient care. Rather, HHS is focusing on billing questions: 1) Did faculty physicians bill appropriately for services administered to Medicare patients? 2) Was patient care performed by residents and billed to Medicare appropriately supervised by attending physicians?

At Hopkins and other teaching hospitals, attending physicians train and supervise medical residents, and they bill for the medical care that they supervise.

But what "supervise" entails has been a source of confusion among physicians and Medicare regulators, say Hopkins administrators. Should the attending physician be always at the resident's elbow or just be accessible by beeper? According to the Association of American Medical Colleges (AAMC), Medicare regulators applied inconsistent standards from region to region. The AAMC also reports that, in auditing pre-1996 records, government auditors may retroactively be applying Medicare billing regulations implemented in July 1996.

"Faculty have made a good faith effort to comply with the complex, vague, and ambiguous documentation requirements," said Miller and President William R. Brody, in a letter to faculty members. --MH

Looking for funding in unexpected places
Gary Ostrander, a biologist who has spent time exploring the waters of San Salvador, is now seeking out sources of funding support for researchers in the Krieger School of Arts and Sciences. Ostrander, 39, was hired last fall as the school's first associate dean for research.

At a time when federal money is getting "tighter and tighter, and harder and harder to get," says Ostrander, "we have to get creative in what we're doing and tap into alternative resources."

One strategy: have Hopkins researchers seek out funds from agencies, like the EPA, that have traditionally been thought only to fund applied research. "In fact, many will fund basic research if it can lead to new procedures that will help them with their applied problems," Ostrander says.

He is also looking to form partnerships with private industries, many of which have downsized their research and development programs in recent years. One idea is to have these businesses kick in money to fund the purchase and upkeep of expensive research equipment, then offer them time on the equipment in return.

Endowing equipment and facilities makes sense, Ostrander says, because that way "you know they are going to be there for a long period of time." He says he also plans to pursue endowments for the humanities and social sciences.

Ostrander came to Hopkins from Oklahoma State University, where he was associate dean of the Graduate College and a faculty member in the departments of Zoology and of Biochemistry and Molecular Biology. He coordinates a research program in the Bahamas to monitor endangered coral reefs, and recently completed a book about the fishes of San Salvador, for which he did the underwater photography. --SD

Peterson appointed hospital president
Ronald R. Peterson '70, a hospital administrator who began a career at Hopkins 23 years ago, was recently named president of Johns Hopkins Hospital. In addition, he is the executive vice president and chief operating officer of the Johns Hopkins Health System, and president of the Johns Hopkins Bayview Medical Center.

Peterson, 48, was named acting president of Johns Hopkins Hospital and Health System in September, when former president James Block resigned.

Colleagues say Peterson is the consummate team player. "He is seen by the medical staff as extremely fair," says Edward Miller, interim medical school dean. "He's ethical beyond reproach." In tapping Peterson, officials veered from hospital tradition by selecting not a physician--as seven of his nine predecessors have been--but a veteran administrator praised for his expertise at cost control.

Peterson, who graduated from Hopkins in 1970, earned a degree in hospital administration from George Washington University. Returning to Hopkins in 1973 as an administrative resident, he began a meteoric rise through the administrative ranks that led to his appointment in 1984 as president of the Johns Hopkins Bayview Medical Center.

Peterson helped the former city-run hospital recoup its financial health, turning a $7 million-a-year loss into a $5 million-a-year gain.

At Hopkins Hospital, Peterson says he will focus on reducing the cost structure "to make our prices more competitive within the regional market." At the same time, he'll push to continue improving "service quality and referral relations with community physicians."

Peterson believes much of the cost savings can be achieved by reducing unnecessary steps, removing unnecessary layers of bureaucracy, and by implementing "smart scheduling" that "directly responds to the requirements of patients." Will such measures mean a loss of jobs? "I would predict that we will employ fewer persons in Hopkins Hospital one year from now than we do today," he says, "but we will probably see growth in jobs in some of our ambulatory settings and within Johns Hopkins Home Care." Peterson says that while he hopes to manage these changes through natural attrition, he "cannot rule out the possibility that some reduction in force may have to occur in the future." --MH

Hopkins Press puts journals on-line
Five years ago, if you needed to research the contents of the academic journals published by the Johns Hopkins University Press, you headed for the stacks in the library. Now you can do much of the same work by typing a word and clicking a mouse, thanks to Project Muse.

One of the first efforts of its kind, Project Muse involves the conversion of all 40 of the Hopkins Press's journals to HTML format, thus making them available over the World Wide Web. Institutional libraries can subscribe to the electronic edition at a 10 percent discount to the print edition cost. This electronic subscription grants access to the Muse journals to anyone who logs on to the Web from the institution served by the library.

The project has been a three-year effort, which began in response to subscribers' discontent over rising journal prices during the last 10 years. "Ways to make publishing cheaper had been discussed in the library world for years," says Ellen Meserow Sauer, co-manager of Project Muse. Electronic publishing seemed a logical answer.

Project Muse is a non-profit venture. Armed with some $750,000 from the National Endowment for the Humanities and the Andrew W. Mellon Foundation, the Muse staff began putting its journals on the Web in 1993. With more than 250 subscribers so far, Sauer says, "We're pleased. It's been very successful."

Does such popularity call into question the future of the print journal? To Michael Jensen, Muse's publisher, the answer is no-- for now. Jensen foresees decades before everyone has shifted to digital access. "We are trying to address our audience in a number of ways," he says. "And until we can read our journals on-line from wherever we happen to be standing, I think there will be a market for print." --KH

Life after the bronze
When Bill Carlucci joined the Hopkins rowing program in fall 1985, he never expected it would lead to an elementary school in Huntsville, Alabama. Since winning the first-ever American medal (a bronze) in the men's lightweight four at the summer Olympic Games, his postAtlanta experience has included endorsement deals with Nike and RayBan, a feature story on the front page of The New York Times, and speaking engagements like this one, in front of Miss Grethel's 5th-grade class.

"How deep was the water?" "Did your boat ever tip over?" "How many Dream Team members did you meet?" All of these questions he answers with aplomb. For the body of his talk, though, Carlucci centers on themes that he readily admits have become standard fare for motivational speakers. Follow your dreams. Perseverance in the face of adversity is the key to success.

For Carlucci, his own unlikely Olympic odyssey began on the waters of the Inner Harbor. At the time, Hopkins crew was only a club sport; at the seasonending Dad Vail Championship Regatta in 1986, Carlucci's freshman boat didn't make it out of the quarterfinals. "It wasn't hard to realize," he says, "that I was getting up at 5 a.m. and sacrificing far too much to embarrass myself like that." With a group of likeminded individuals, Carlucci set out to turn the program around. By his senior year, the team won Dad Vail gold.

After graduation, he moved to Philadelphia to live and train out of Vesper Boat Club, and by 1990 had won his first national championship as a member of the club's top boat. But then-U.S. lightweight national team coach Stuart MacDonald refused to invite him to the national team selection camp. "You're too short," MacDonald told the 5-foot 9-inch Carlucci. "Maybe you should find another sport. How about tennis?'" Nonplussed, Carlucci says he resolved to become so good that he "couldn't be ignored."

He succeeded. By 1995, he was the best rower in the U.S. Olympic lightweight rowing camp. "Bill was the top guy, every single day," says national team coach Michael Teti. "He's driven, he's tenacious, he's relentless, he doesn't complain." Teti and coach Curtis Jordan selected Carlucci to row in the Olympics in the critical stroke seat, where he would be responsible for setting both the rate and the rhythm of the boat.

In Atlanta, Carlucci's boat advanced to the finals after winning its semifinal and recording the fastest time ever in its Olympic event. Facing the talented Danish and Canadians, the U.S. four came within 2.7 seconds of Olympic gold.

"The first thing I thought when we got to the finish line was, 'Damn,' because we really wanted to win." says Carlucci. "But that feeling only lasted 20 seconds. We didn't win, but we did get a medal in the Olympics and we did it in our own country."

Thus, on the shores of Lake Lanier with a shiny 18-ounce bronze disk around his neck, Carlucci finally received the tangible reward that, for him, justifies 11 years of toil in an anonymous sport, a yearly income as low as $5,000, and innumerable nights spent on unheated boathouse floors.

Carlucci has now changed the label on his clothing from Nike to Brooks Brothers as he ventures into the corporate world. "I seriously considered continuing to row," he says. "But had I made that choice, I would have been doing it for the wrong reason: to avoid doing something else." --JY