National Jewish Health: Not too big, not too small

DR. MICHAEL SALEM, president and CEO of National Jewish Health, identifies a Catch 22: In contemporary medical facilities, you can’t get too small, and you can’t get too big.

If you get too big, you can attract quality faculty for research, but can’t provide the opportunities for the intimate exchange of ideas, for natural interaction and cross-fertilization.

And you can’t provide personalized medicine.

If you get too small, you don’t have the resources for either the research or the tailored clinical approach.

That leaves NJH working hard to grow — and to stay small.

Two directions at once.

It’s a tricky balance. A major misstep in either direction would derail National Jewish from, in Dr. Salem’s grand vision for National Jewish, “continuing our mission for the next 100 years.”

“We’ve grown, while retaining a special experience — the ultimate in patient care,” says Dr. Salem. By ultimate patient care, he means patients for whom all the normal treatment protocols have failed, necessitating what National Jewish specializes in: individualized, “personalized medicine.”

Examples of NJH’s growth:

• Partnership with Mt. Sinai in New York to provide respiratory care in NY, New Jersey and Connecticut (“When are you going to open in New York?” many of NJH’s trustees there asked).

• Research, teaching and clinical collaboration with CU.

• Clinical collaboration with HealthOne facilities (such as Rose Medical’s ICU).

• Joint operating agreement with St. Joseph.

• Medical care in Colorado rural areas (“a lot of data comes in here from there at night,” says Dr. Salem). “We have a lot of touch points around Colorado,” some 25 medical treatment partnerships.

Examples of NJH’s smallness:

NYU’s medical centers have $6 to $9 billion in annual revenues. Long Island Jewish: $9 billion. National Jewish: about $250 million.

“With all the consolidation in health care,” observes Dr. Salem, “with the 12-minute doctor appointment, we worry.”

He returns to a favorite phrase and focus: personalized medicine. And to academic medicine — research — too: “The pressure is on, saying in effect, ‘Research can be done only in big universities now. We think that’s not true. We collaborate with universities.’”

NJH NEEDS to remain small to sustain one word: lungs.

Dr. Salem points out:

Cleveland Clinic — think heart.

Sloan Kettering — think cancer.

National Jewish — think lungs.

“For us, lungs are the center of the universe.”

Lung cancer is the worst cancer killer — more than breast, colon and prostate cancer combined.

To nurture its research, clinical and personalized foci, NJH can’t grow into a mega-medical center for which the bottom line is mainly     . . . the bottom line.

To grow too big — is to die.

Not to grow — is to die.

That’s the tension that governs NJH’s realization of its 10-year vision (2007-2017).

Which is actually just the background noise.

The foreground, Dr. Salem sums up this way:

“I’ve never been to another medical facility where the people are so devoted to the mission. I think that stems from our charitable origins.”

The motto at the time of origin was, “None may enter who can pay, none can pay who enter.” Dr. Salem states the trenchant, 21st-century equivalent: “At National Jewish it’s still first come, first served — whether insured or not.”

The goal remains to keep NJH #1 in respiratory care and related diseases; to bring clinical and research together on behalf of the patient.

UNDER THE leadership of Dr. Salem and his boards, he set forth a 10-year vision and strategy in 2007. Now, by 2015:

• Check, the Center for Genes, Environment and Health. It’s up and running, to understand the genetics of lung disease; to try to find out beforehand what disease a person is prone to.

• Check, the Institute for Advanced Biomedical Imaging. It’s up and running, to diagnose diseases earlier, “and save lives.”

• Check, a minimally invasive diagnostic center. It’s up and running, to test without putting the patient at risk.

• Don’t check: Recruiting 75 new faculty. Don’t check because National Jewish has doubled that, hiring 150 new faculty.

National Jewish’s history is in tuberculosis. Today, NJH sees patients with “cousins of TB, particularly in women,” says Dr. Salem.

National Jewish’s history since 1978 includes asthma. Dr. Salem cannot be contained as he expatiates, illustrates and praises. Just one example:

Dr. Mike Weschler — recruited from Brigham and Woman’s in Boston — is involved in clinical trials testing asthma frequency in the minority population.

Dr. Salem mentions “therapy resistant asthma,” exactly the kind of worst case scenario that National Jewish wants to apply personalized medicine to.

What’s beyond 2017? “With all the consolidation going on in health care, it is very important to the National Jewish board to be a differentiated place,” says Dr. Salem.

“Medicine has the potential to be more commoditized.

“We want to be a place to get more time with the doctor and figure out the individual program. We want to continue the ideals, the individuality, of National Jewish for the next 100 years.”

After 2017:

• Expect more strategic alliances.

• Expect a Center for Outpatient Health on the previous Gove property (13th Ave. and Colo. Blvd.).

• Expect a major, five-year capital campaign, now in the beginning stages, with a “very large number.”

• Expect worries: about threats to NIH and grant research funding; about financial pressures that would not allow individualized therapy; about pressures on medicine generally — the 12-minute doctor appointment.

• Expect more research. “If I can predict the illnesses you are prone to and the specific treatment for you and your issue, you’re getting the best value in health. That’s what we’re after: the best outcome at the lowest cost — the value equation in health care.”

• Expect continued dedication from National Jewish’s boards. Dr. Salem illustrates:

“Evan Zucker, vice president, has great experience with doing large transactions. He’s been on the board for 20 years.”

He has tremendous expertise.

“Rich Schierburg, chair, has great relationships with members of boards of other entities he is active with.”

Again, expertise in the room.

Eighty-five percent of NJH’s 38-person board is from Colorado, with an active national council of trustees around the country.

DR. SALEM juggles a lot of balls: research, clinics, partnerships, fundraising, board development.

He travels a lot. He has a lot of researchers, clinicians, partners, potential partners, and supporters to stay in contact with, or to recruit.

“I have a lot of satisfaction,” he says. “My work is more of an avocation than a vocation.”

He enjoys NJH’s good relationship with the City of Denver, Denver Public Schools, Mayor Hancock and Gov. Hickenlooper.

He closes with a point of pride that, in a way, sums up National Jewish’s history, mission, modus operandi and future: the Morgridge Academy (a new name for the Kuntzberg school).

This is the only free, and free standing, school on a medical campus.

It’s for medically fragile students, grades K-8, who can’t be handled in a regular school. Three nurses are attached to the school. Eighty-five percent of the students are on a free lunch program. It has a huge indoor pool and other exercise facilities.

It’s perhaps the ultimate example of the human face that National Jewish puts on its research, its personalized medicine and its plans to stay vital for the coming century.

Copyright © 2015 by the Intermountain Jewish News