Reinforcing Clinical Care

Associate Vice Chancellor James P. Crane led the reorganization of the clinical practice, providing improved patient services and long-term sustainability at the medical school.

By Diane Duke Williams

James P. Crane, Associate Vice Chancellor for Clinical Affairs

In the mid-1990s, there was a firestorm brewing in American health care. Managed care kept growing as clinical revenues declined. Cutbacks were on the horizon in clinical care funding from Medicare, research funding from the National Institutes of Health, and Medicare-related graduate medical education payments. Medical schools began losing money, and some were even taking the dramatic step of selling their teaching hospitals.

The Washington University School of Medicine tackled the challenge by tapping James P. Crane, associate vice chancellor for clinical affairs and a key administrator at the medical school, to lead a faculty-oversight committee to assess the rapidly changing health-care forces. After the committee announced its results, the School of Medicine decided in 1997 to create a unified multi-specialty medical group called the Faculty Practice Plan (FPP).

The FPP's primary goals were to make the medical school's clinical practice more efficient and more responsive to the needs of patients, referring physicians, and health-care insurers. It would provide more effective infrastructure and support for clinical services, negotiate contracts with 43 major insurers in the St. Louis area, streamline billing and collections, and establish strategic direction for the School's 13 clinical departments.

The reorganization would enable the School of Medicine to better compete in an increasingly competitive health-care market and provide a clinically diverse patient base in support of the medical school's teaching and research missions.

"A vibrant clinical practice is so important to our teaching and research missions," says Crane, who also was named chief executive officer of the FPP. "Our clinical practice provides an essential platform for bringing new discoveries and the latest medical innovations to the bedside, and it also provides a vital training ground for the next generation of health-care professionals."

Before the FPP was created, 13 clinical departments with 55 divisions were practicing at 32 locations within three city blocks on the Medical Campus. No central location existed for patients to seek outpatient care, despite the fact that many patients had complex medical problems that required the expertise of multiple subspecialists.

Through the FPP, Crane led the effort to implement the Campus Integration Plan, a new vision for the Medical Center. On the North Campus, new buildings house multidisciplinary clusters of outpatient services while others on the South Campus integrate inpatient care in a more rational and cost-effective manner.

As part of the $364-million Campus Integration Plan, a 14-story outpatient care facility called the Center for Advanced Medicine, or CAM, opened in 2000 on the North Campus. The CAM holds 14 multidisciplinary clinical centers with related ancillary and diagnostic testing conveniently located nearby.

"Historically, we were physician-focused in the way we provided medical care," says Crane, who also is a professor of obstetrics and gynecology. "The CAM is patient-focused. We've had a paradigm shift."

Today, the FPP has 979 physicians and ranks as the second-largest academic medical practice in the United States.

As the FPP's chief executive officer, Crane is responsible for establishing strategic direction and coordinating clinical programs across the School of Medicine's now 14 clinical departments, implementing school-wide standards of clinical care, and overseeing key services and infrastructure to help clinical departments provide the best patient care.

He also is focused on new goals for the FPP. These goals include expanding clinical practices in suburban areas of St. Louis, enhancing patient safety, and implementing an enterprise-wide electronic medical record system that will improve productivity and enhance patient care by providing the faculty with instant access to comprehensive outpatient and inpatient medical information.

Additionally, he spends a fair amount of time on public policy. For the past three years, Crane worked with the state medical association and other groups to pass meaningful tort reform legislation in Missouri, and he currently is working to get a tobacco tax initiative passed to discourage cigarette smoking and reduce the burden of tobacco-related disease among Missourians.

His colleagues say Crane has a remarkable talent for bringing people with diverse interests and agendas to a common purpose.

"You have to be a good listener and try to put yourself in the other person's shoes," Crane says. "In the end, consensus is about compromise and working toward the common good."

Crane has a long list of accomplishments. When he joined the Washington University faculty in 1977, he established the first prenatal diagnosis program in Missouri in his role as chief of the genetics division within the Department of Obstetrics and Gynecology. In addition to being revered by his patients, he and his staff pioneered the development of new prenatal diagnostic techniques and established a cytogenetics laboratory for prenatal testing, a screening center for neural tube defects, a genetic counseling service, and a hotline for physicians and patients who have concerns about potential drug exposure during a woman's pregnancy. He also helped start Missouri's first in vitro fertilization program, which led to the birth of the state's first IVF baby in January 1985.

He still sees about 60 to 80 patients per month, which he greatly enjoys for the intellectual challenge and patient contact. "I can't envision ever giving that up," he says.

Crane feels fortunate for the opportunities he has had at the University and says he sometimes has to pinch himself to make sure it's all real.

"It's hard to envision a higher and more compelling mission than improving the health and lives of people. Providing the best and latest in medical care to our patients and training outstanding health-care professionals to serve our community are noble causes," Crane says. "I feel blessed to have had the opportunity to serve the University and our community in this way."

Diane Duke Williams is a free-lance writer based in St. Louis.


"It's virtually impossible for me to imagine the clinical operation of the School of Medicine and the Medical Center without Jim's brilliant leadership. He is the brain trust and organizational genius of the highly successful Washington University Physician Network. He also has contributed his appreciable talents to other major activities at the Medical Center and to important outside organizations, such as the St. Louis Regional Health Commission. He combines an incredibly large knowledge base, amazing diligence, assiduous attention to detail (without losing the big picture), and remarkable persuasive ability. And he's a wonderful person."

—William A. Peck, the Alan A. and Edith L. Wolff Distinguished Professor of Medicine and Director of the University's Center for Health Policy


"Crane embodies all that is great in a Washington University leader. He is a passionately committed citizen of the institution and its multiple missions. He is deeply invested in our being the very best, especially in health care. The University is a far, far better place because of Jim Crane."

—Alan L. Schwartz, the Harriet B. Spoehrer Professor and Head of the Department of Pediatrics


"We are very fortunate to have James Crane as head of the Faculty Practice Plan. He brings truly remarkable leadership to dealing with the constant changes in health care and understands the factors that affect our ability to remain a premier medical center. He also is proactive and passionate about providing better care for our patients. There are very few faculty members who have done more to contribute to the success of Washington University as a center of clinical excellence."

—Larry J. Shapiro, A.B. '68, M.D. '71, Executive Vice Chancellor for Medical Affairs and Dean of the School of Medicine


"One of the University's most important contributions to our community and the world is the excellent medical care provided by Washington University physicians. Dr. Crane is one of our most important leaders in clinical medicine. He is tireless in his efforts to bring the best medical care to the people we serve, and he does so with sensitivity and commitment. Jim is talented, dedicated, and caring—we are fortunate to have him as a leader in the practice of medicine at Washington University."

—Mark S. Wrighton, Chancellor