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Keys, Please!

In November, after five years of batting around the idea, the medical campus instituted a test run for valet parking at the Outpatient Center, the site deemed most workable until glitches are ironed out. The service will cost $5 on top of regular fees and will guarantee parkers that they will wait no more than five minutes from the time they pay their garage fee to the time they step back into their cars.

Why this consummate gesture of first-class pampering should have taken so long to become part of the Hopkins customer package isn't quite clear. But according to Joe Coppola, director of security services, time and again plans to institute the parking assist have been foiled by "concerns about traffic, monetary considerations, even the question of whether patients wanted it and whether it's something we really need."

Last year, however, as the administration's mandate for service excellence became a call to action, Coppola and Larry Cohen, head of parking (who once owned a valet parking service and also introduced a similar service at the Hospital of the University of Pennsylvania before coming to Hopkins) began tackling long-standing deterrents one by one. Then they began crunching numbers to find a way to provide the add-on without expecting the already financially strapped medical center to absorb the cost. The service would float, they realized, if customers paid a supplement and Hopkins only picked up the difference in the event of a shortfall. Now, a 90-day trial run is determining how many people actually will pay five more dollars to avoid winding up and down five levels of garage.

Meanwhile, parking gurus have scrutinized similar services at other medical centers and hotels and restaurants around the Inner Harbor to set performance standards. As a result, all drivers have been handpicked after thorough background checks, drug testing and driving assessments, and have been fitted with snappy blue button-down shirts, khaki pants, Children's Center ties and brown walking shoes.

The timing of the pilot, the parking office says, comes at the right moment. "Winter's when people tend to appreciate having someone park their car." -- KL

New Tools of the Trade

When neurosurgeon Rafael Tamargo, M.D., meets with prospective patients, he comes well equipped. His toolbox is a data base full of what are called "outcomes analyses" for about 530 people treated at Hopkins for cerebral aneurysm surgery in the last seven years. The numbers show the mortality rates for those Tamargo's operated on versus the average mortality rates statewide for this operation. And for good measure, he'll even throw in his curriculum vitae. Then it's up to the patient to use this report card to see how Tamargo and Hopkins stack up against competitors.

Rafael Tamargo performs the high- risk cerebral aneurysm surgery.

The fact is, as today's health-savvy Americans decide in whose hands they want to place their life or their health, they're beginning to apply the same techniques they use in car buying to hospitals and physicians. And says Tamargo, "We need to respond to their questions with the most honest and helpful information."

Outcomes analysis has its good and bad sides. On the one hand, statistics can show that the statewide average for high-risk cerebral aneurysm surgery is 32 percent, that Hopkins' mortality rate is 5 percent and that one Hopkins neurosurgeon has an even better rate of 2 percent. The data also can demonstrate a hospital's volume for a specific procedure. And that, according to studies--particularly in New York state, where physician and hospital outcomes are published routinely--is meaningful information, since medical centers that use an approach regularly usually are more adept at it and charge less.

But on the flip side, certain dangers lurk in how the numbers are reported, especially in regard to calculating risk adjustment factors. Studies show that such variables as a patient's socioeconomic status, race, gender, age and other systemic
medical problems can affect outcomes in many medical procedures. A hospital that routinely treats older, sicker patients, therefore, might report a higher morbidity rate for a specific procedure, which in no way reflects less competence on the part of its physicians.

"The health care industry hasn't yet come up with a uniform method of reporting outcomes because of these complexities," says Nancy Peacock Heath, a national health care consultant.

And in order to attract patients, several cases also have been reported in which surgeons falsified their outcomes--an ethical landmine that concerns surgeons like Tamargo. "If a surgeon says he's never had a death from cerebral aneurysm surgery, then I'd say that surgeon hasn't performed many such operations, isn't aware of his outcomes or just simply is not telling the truth," he says.

What's even more worrisome is that outcomes data could influence a physician's choice of patients. Phillip Dobrin, M.D., surgeon and chief of staff for the Veterans Affairs Medical Center in Salt Lake City, notes that at another VA hospital, cardiac surgeons began avoiding very high-risk operations after the VA central office complained about its 10 percent mortality rate. "The [hospital's] mortality rate quickly dropped to acceptable levels," he says. "High-risk patients were still dying, but without surgical intervention."

Yet, everyone seems to agree that outcomes analysis is here to stay. Says consultant Heath: "I tell my clients that thinking as a consumer, I'd be more interested in a physician or hospital that has kept track of this information than ones who don't." It's scary, she adds, that so little attention has been paid to outcomes in the health care field. "No other industry could get away with this lack of information."

Tamargo agrees. "You have an easier time finding the right mutual fund to invest your money in," he says, "than finding the best doctor to entrust your life to. I find that shocking." -- PG

From the Bench to the Board Room

Fred Sanfilippo's passion for transplantation goes back to his graduate student days, when he investigated how the immune system could be turned off to specific antigens. Little did Hopkins' chief
of pathology know that his early work would become the first step in a career as both a researcher and a budding entrepreneur.

Sanfilippo founded a Hopkins

Today, Sanfilippo, M.D., is a founder and soon-to-be board member of VIVEX, a Hopkins spin-off company that plans to market six products directly resulting from technology developed by him and other Hopkins scientists that could revolutionize organ transplants. The products range from solutions that arrest donor organ deterioration to suppressors that could knock out antigens signaling the immune system to reject an organ.

Sanfilippo is among a growing number of academic scientists who are tucking their innovations under their arms and heading into the world of startup companies based at their own universities. Becoming business people, they've found, gives them greater control over their own discoveries as they move to the marketplace.

Several factors have ignited interest in startups at universities nationwide. Not only do faculty achieve ongoing control over the fruits of their research, but the university secures a potential new source of revenue. According to the Association of University Technology Managers (AUTM), between 1991 and 1995, 1,100 such businesses have sprung up, two-thirds involving life sciences discoveries. Leading the pack with 64 startups is the Massachusetts Institute of Technology. The University of Minnesota has 32 and the University of Pennsylvania, 14.

Since Hopkins adopted new rules six years ago to encourage startups, the University has formed 12 companies. Reflecting the nature of startups everywhere, their net equity is high on paper, but short-term revenue is almost nil. The potential, however, is eye-opening. On average, says Howard Califano, J.D., director of Hopkins' Office of Technology Licensing, each startup could be worth around $200 million, of which Hopkins could see 15 to 25 percent through stock ownership plus royalties.

To become a Hopkins startup candidate, a technology must undergo a grueling viability and market analysis taking up to six months. If it passes that scrutiny, a company is formed, a CEO hired, a business plan developed and the technology shopped around to potential investors. The strategy, says Califano, is to go public or be acquired by another company. Along the way, the failure rate is as high as 50 percent. He cites several pitfalls: tough competition, technology too expensive to develop and technical failure.

Still, researchers entering science today increasingly ask about an institution's commitment to technology licensing. "It's that intense desire to guide the discovery that was born in your laboratory all the way to the marketplace and see it have an impact on medical care," Sanfilippo explains.

At first glance, the outlook appears rosy for VIVEX. The United States, Japan and Western Europe spent $18 billion in transplant activities in 1995. With a vastly improved donor organ supply, at least another 100,000 transplants could be performed annually. Still, says Stephen Sammut, a venture capitalist who heads a committee for the Association of University Technology Managers and is serving as CEO for VIVEX, the company faces stiff competition from pharmaceutical giants and other, non-Hopkins startups.

Whatever the future holds, the experience, says Sanfilippo, has been educational. "I've learned a lot about how basic discoveries get transferred into applied technologies. Now, I want to see our technology out there saving lives."