Update on Activities to expand GME in Georgia. Ben Robinson, MPA Primary Care Summit April, 16, 2015

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1 Update on Activities to expand GME in Georgia Ben Robinson, MPA Primary Care Summit April, 16, 2015

2 The Way We Were cir , , , , , , ,000 Projected Supply & Demand of Physicians, Shortage of 130,600 Physicians by 2025 Physician Supply (All Specialties) Physician Demand (All Specialties) Physician Shortages across nation expected to exceed 90,000 in next decade Georgia per capita physician workforce ranks 40 th in US (2009) * GA per capita rate * US per capita rate Georgia s rank in terms of active primary care physicians was even lower.

3 The Way We Were cir GA s response at UME level robust 1 new medical school in GA 2 new 4 year campuses Increase in class size at all GA medical schools Will result in over 80% growth in medical school enrollment by Per capita medical student numbers improving (18.5/100,000 in 2000, 21.8/100,000 in 2010)

4 The Way We Were cir But one sided Growth in UME occurring at twice the rate seen in GME UME enhancements by % Growth in GME (at current rate) by % Per capita GME capacity has barely grown in last decade in in 2010

5 The Way We Were cir In 2010 Georgia: Ranked 39th among the 50 states in total residents per 100,000 population. Georgia had 20.8 residents per 100,000 US had 35.7 residents per 100,000 To meet the national average of 35.7 residents per 100,000 population, Georgia would have to add a total of approximately 1,450 residency positions. Only one state surrounding Georgia (Florida at 17.9) had a resident to population ratio lower than Georgia s. To reach the Southeast average of 24.0 residents per 100,000 population, Georgia would have to add a total of approximately 315 residency positions.

6 The Way We Were cir Growth in core specialty programs has been limited Primary care/general surgery training capacity has diminished, factoring for population growth Growth in per capita GME numbers has been driven by growth in GME outside of core specialties Change in Residency Education (GME) Capacity, Change % change Total Residency Positions 1,780 2, % Total Primary Care Positions % Total General Surgery Positions % Total Core Specialty Positions 951 1, % Total Positions All Other 829 1, % Total Residency Positions per 100, % Total Primary Care Positions per 100, % Total General Surgery Positions per 100, % Total Core Specialty Slots per 100, % Total All Other Positions per 100, %

7 The Way We Were cir Location of GME programs plays a strong role in predicting practice location GME programs in Georgia poorly distributed Majority of GME efforts occurring in Atlanta, Macon, Savannah and Augusta 2/3 of GME slots are in Atlanta and Augusta Predominately modest sized family medicine programs outside of these areas Albany, Rome, Columbus

8 Plan moving forward Goal - Increase number of GME programs in Georgia Create 400 new residency positions in GME naïve Georgia hospitals: Increasing the number of residents in Georgia to match the southeastern rate Ensure concentration on primary care and general surgery Better distribute GME across the state

9 Plan moving forward Goal - Increase return on investment made to medical education in Georgia Georgia has a high overall retention rate for graduates of its medical education system GME programs have a well understood impact on retention Likelihood of retention maximized when combine both UME and GME in state In State Retention: 50 th Percentile (% Active physicians practicing in state, 2008) 37% Completed UME in state 45% Completed GME in state 67% Completed both GME and UME in state

10 Strategy Plan moving forward Bridge the GME knowledge gap facing hospitals considering GME Provide consulting services on GME as requested by hospitals: Facilitate conversion of GME naive hospitals into teaching hospitals Maximize financial supports for new GME programs Facilitate better distribution of new GME programs across the state Monitor policy landscape and devise policy responses to render GME more cost effective Utilize GME expertise within state of Georgia to facilitate effective GME growth

11 Plan moving forward Strategy Create a pool of matching funds to support GME start-up costs for strategically positioned Georgia hospitals Designate funds for start up costs Require match by hospitals to access these funds Prioritize primary care specialties and general surgery

12 Progress to date ATHENS REGIONAL MEDICAL CENTER CANDLER HOSPITAL CARTERSVILLE MEDICAL CENTER COLISEUM MEDICAL CENTER COLISEUM NORTHSIDE HOSPITAL DOCTORS HOSPITAL of Augusta GWINNETT MEDICAL CENTER HAMILTON MEDICAL CENTER HENRY MEDICAL CENTER, INC JOHN D ARCHBOLD MEMORIAL HOSPITAL NORTH FULTON REGIONAL HOSPITAL NORTHEAST GEORGIA MEDICAL CENTER NORTHSIDE HOSPITAL NORTHSIDE HOSPITAL CHEROKEE NORTHSIDE HOSPITAL FORSYTH PALMYRA MEDICAL CENTERS PIEDMONT FAYETTE HOSPITAL PIEDMONT NEWNAN HOSPITAL, INC REDMOND REGIONAL MEDICAL CENTER SAINT JOSEPH'S HOSPITAL OF ATLANTA, INC SOUTH GEORGIA MEDICAL CENTER SOUTHEAST GEORGIA HEALTH SYSTEM- BRUNSWICK CAMPUS SOUTHERN REGIONAL MEDICAL CENTER ST FRANCIS HOSPITAL, INC ST JOSEPH'S HOSPITAL - SAVANNAH ST MARY'S HOSPITAL OF ATHENS TANNER MEDICAL CENTER - CARROLLTON TIFT REGIONAL MEDICAL CENTER ATHENS REGIONAL MEDICAL CENTER CANDLER HOSPITAL CARTERSVILLE MEDICAL CENTER COLISEUM MEDICAL CENTER COLISEUM NORTHSIDE HOSPITAL DOCTORS HOSPITAL of Augusta GWINNETT MEDICAL CENTER HAMILTON MEDICAL CENTER HENRY MEDICAL CENTER, INC JOHN D ARCHBOLD MEMORIAL HOSPITAL NORTH FULTON REGIONAL HOSPITAL NORTHEAST GEORGIA MEDICAL CENTER NORTHSIDE HOSPITAL NORTHSIDE HOSPITAL CHEROKEE NORTHSIDE HOSPITAL FORSYTH PALMYRA MEDICAL CENTERS PIEDMONT FAYETTE HOSPITAL PIEDMONT NEWNAN HOSPITAL, INC REDMOND REGIONAL MEDICAL CENTER SAINT JOSEPH'S HOSPITAL OF ATLANTA, INC SOUTH GEORGIA MEDICAL CENTER SOUTHEAST GEORGIA HEALTH SYSTEM- BRUNSWICK CAMPUS SOUTHERN REGIONAL MEDICAL CENTER ST FRANCIS HOSPITAL, INC ST JOSEPH'S HOSPITAL - SAVANNAH ST MARY'S HOSPITAL OF ATHENS TANNER MEDICAL CENTER - CARROLLTON TIFT REGIONAL MEDICAL CENTER WELLSTAR - Kennestone UNIVERSITY HOSPITAL - Augusta

13 Progress to date Number of Programs Minimum Number of Residents Maximum Number of Residents Specialty Internal Medicine Family Medicine OB/GYN General Surgery Emergency Medicine Psychiatry Transitional Year Total

14 Progress to date Total New Residents Per Year/with Gwinnett Expansion FY 15 FY 16 FY 17 FY 18 FY 19 FY 20 FY 21 FY 22 ARMC St. Mary's Gwinnett South GA Redmond Regional Tanner Wellstar University Total

15 Progress to date As of July 1, 2015, Georgia will have 26 new GME slots filled Strong Georgia focus seen in background of these residents Gwinnett Family Medicine PGY1 5 from Georgia PGY2 4 from Georgia The other strong family ties to Georgia (partner from GA.) Gwinnett Internal Medicine PGY1 3 from Georgia 1 from Chattanooga PGY 2 Is from Georgia St. Mary s Internal Medicine PGY1 6 from Georgia (academic or family ties) 2 from the Southeast

16 Moving forward: Georgia seems to be succeeding in expanding GME On target with number of new residencies slots Vast bulk of new programs in target specialties All new programs are at hospitals that are new to Medicare GME (or are reclaiming Medicare GME cap space) Expansion occurring in areas not normally impacted by GME Moultrie, Athens, Lawrenceville, Carrollton Effort in Rome would more than triple current GME outputs Additional success still potential and pending Additional hospitals considering GME Spalding Regional Northeast Georgia Healthcare System Other medical schools consulting with potential hospital partners Success is within reach

17 Moving forward: Required to ensure success with current partner hospitals Additional time needed to land several new programs Continue funding to the Board of Regents Ensure long term state funding for new residency slots Expand funding and capitated slots provided by the Georgia Board for Physician Workforce New funds should cover new slots created in a given year while maintaining prevailing capitation rate Communicate need to expand/remove existing cap on Medicare GME funding Develop additional methods to make Georgia GME programs attractive to Georgians

18 Moving forward: Required to ensure success with current partner hospitals Funding removed from the Board of Regents GME expansion budget will need to be restored if Northeast Georgia.. Confirm their desire(s) to establish GME programs

19 Questions?