Funding Education in the Post HealthCare Reform Era

Transcription

1 Funding Education in the Post HealthCare Reform Era Duane Mezwa MD FACR Professor and Chair Diagnostic Radiology and Molecular Imaging Oakland University William Beaumont School of Medicine

2 Disclosures No Financial Disclosures Trustee, ABR Vice Chair, Radiology RRC

3 Key Points to Cover Brief Overview of GME Funding Understanding GME funding in your system Demonstrating the value of your program Describe approaches to sustain mission balance in the setting of diminished resources

4 Medicare/CMS Funding Direct Medical Education Payments (DME) Indirect Medical Education Payments (IME)

5 What is the Funding specifically for? DGME funding is for Intern & Resident compensation, Faculty Supervision, GME Office Admin costs & Hospital overhead IME funding is to recognize a hospital s higher operating costs that result from teaching activities

6 What Payers fund GME costs? MEDICARE (federal program for the aged & disabled) MEDICAID (federal & state program for the financially challenged) TRICARE (federal program for active & retired military) Private Insurers- BC/BS

7 WHY DO WE GET THIS FUNDING? CMS realizes that teaching hospitals incur more costs than non-teaching hospitals and feels an obligation to pay THEIR share They also realize that without teaching hospitals, future doctors would not have real life training grounds to perfect their skills

8 BBA of 1997 Introduced the cap CMS reimbursement frozen at position number in 1996 Planned phased - in reduction of IME adjustment Very limited provision for new programs

9 Things to know CMS is not the only source of GME Funding According to the AAMC: Medicare provided about 40% of DGME expenditures in % of teaching hospitals are over cap 35% of teaching hospital are under cap 11,000 FTEs being trained over the cap

10 Demonstrating the Value of Your Program

11 Demonstrating Value to Chair/DIO Will Residents/Fellows enhance: the academic mission of the school/department/division? other clinical services/departments? clinical revenue? recruitment of faculty? recruitment of other residents in Dept

12 Demonstrating value to your teaching hospital How will residents enhance: Clinical revenues (decreases in LOS, ICU days, etc?) Clinical Outcomes Patient Satisfaction Staff satisfaction

13 Demonstrating value Don t assume that others know what you know Know the mission of your hospital Opportunities for collaborative or multidisciplinary projects/grants Potentially big benefit for small investment Because it s the right thing to do

14 In Summary. GME Funding is a little complex Understand how your system works and who can tell you what you don t know Be ready to demonstrate your program s value

15 Do You Understand Your GME Office?

16 Beaumont Health System RESIDENCIES & FELLOWSHIPS RESIDENCIES ACGME-accredited 19 (includes 1 dually-accredited by ACGME & AOA) SUBSPECIALTY FELLOWSHIPS ACGME-accredited 21 ACGME accreditation 10 not available

17 Beaumont Health System GME Cap & Number of Trainees Beaumont Hospital GME Cap Resident/ Fellow ITE s Variance Royal Oak Troy Grosse Pte TOTAL

18 Growth of Beaumont Health System System Characteristics Variance Hospitals % Beds 1,118 1, % Admissions 56, , % Surgeries 48,119 73, % EC Visits 122, , % Outpt. Visits 1,002,183 2,343, % Residents & Fellows % GME Cap %

19 GME Reimbursement January December 2014 Source Medicare Direct (DME) Medicare Indirect (IME) Medicaid GME BCBSM GME Royal Oak Troy Grosse Pointe Total $16,506,740 $1,284,263 $1,635,814 $19,426,817 $40,278,396 $2,652,667 $1,871,399 $44,802,462 $3,667,958 $162,410 $173,242 $4,003,610 $9,353,510 $548,870 $279,926 $10,182,306 TOTAL $69,806,604 $4,648,210 $3,960,381 $78,415,195

20 GME Reimbursement Per Resident Total GME Reimbursement: $78,415,195 Divided by 343 within-cap positions = $228,615 per capped Resident Divided by 455 total positions = $172,341 per Resident AAMC -$150,000/yr to train a resident

21 GME Budget: 2014 * Description Actual Revenue Medicare Direct Medical Expense (DME) $19,426,817 Medicare Indirect Medical Expense (IME) $44,802,462 Medicaid GME $ 4,003,610 BCBSM GME $10,182,306 TOTAL GME REIMBURSEMENT $78,415,195 Expense GME-Related Total T Allocation (includes GME Director) $10,313,904 GME Office: Salary + Benefits $ 378,096 GME Office: Expenses, Travel, etc. $ 18,500 Resident / Fellow Salaries + Benefits (455 FTE s) $29,625,335 Training Expenses: Licenses, Dues, CME, Food, Courses $ 1,759,544 Departmental GME Educational Funds ($1,500 x 455 Resids.) $ 682,500 Program Coordinator Salaries + Benefits $ 1,910,715 Indir. Exp. / Allocated Corp. Overhead (was $14,606,366 in 2012 ) $ 0 TOTAL EXPENSES $44,688,594 NET GAIN / (LOSS) $33,726,601 * Revenue received in 2014; Expenses budgeted for 2015 ** Corporate overhead is no longer allocated to GME

22 Costs of Replacing Residents With Midlevel Providers 2015 Beaumont Health System Data Provider Residents / Fellows Nurse Clinicians Nurse Practitioners Physician Assistants Salary + Bene Mean Salary + Bene Range Hours Worked $65,923 $61-78, $90,128 $73-98, $120,429 $96-147, $124,085 $99-162, CRNA s $208,924 $208,924 40

23 Beaumont Health Accredited GME Programs Legacy Institution Beaumont Botsford Oakwood TOTAL TOTAL TOTAL Number of Training Programs (Number of Trainees) Residencies Fellowships Podiatry Residency Allopathic Osteopathic Allop/Osteo Allopathic Osteopathic Allop/Osteo 18 (379) 11** (128) 29 (507) 14 (143) 8 (61) 22 (204) 53 (764) 1 (24) 1 (29) 2 (53) 21 (55) 3 (10) 24 (65) ** Includes 6 programs sponsored by WSUSOM 86 (868) 7 (18) 7 (18) 31 (83) 1 (12) 1 (9) 2 (21) 2 (21) TOTAL 40 (458) 22 (173) 24 (237)

24 Alternative Sources of Funding State-based initiatives and partnerships Philanthropy Foundations Industry sponsorship Foreign government sponsorship Individuals offering to work without payment Parents offering to pay

25 Midwest Chairs Survey 11 questions 11 respondents

26 Planning to Increase or Decrease No Change x7 Decease x2 Likely will be asked to decrease x2

27 Do you anticipate you might be asked to decrease your numbers? Yes x5 Has already happened-we are shrinking over next 3 years No but will adjust down when IR/DR begins None additional No x3

28 Have you looked for alternative sources of funding? No x6 Yes x3 Considered internal departmental briefly, but otherwise No.

29 Any ideas for alternative sources of funding for GME? Partnership with local hospital in exchange for coverage New VA IR program paying for 1 resident and one fellow in IR, Private group paying for a mammo fellow International institutions, limited success Industry for fellows, alumni society for residents Big department endowments Alumni...Industry...Pharma

30 Innovation at OUWB Annual Giving Campaign $50,000 Foundation Gifts for Education Sharing the Gifts from other Departments Residency and Fellowship Checks-$15,000 Visiting Fellowships and Observerships Shared Savings Program-$250,000 in 2014 Partner with local private practices

31 HR.2124/S.1148 Distribution of 15,000 slots over 5 years Teaching hospitals receive priority if: Located in states with new schools or branch Affiliated with VA medical centers Focused on community-based or hospital outpatient training.or Identified as EHR meaningful users Still focused on Primary Care

32 States invest in Residencies Growth in Med Schools outpaced residencies Georgia-$14M to start residency programs Texas-offers $150,000 in planning grants to launch new programs and $250,000 to develop them. $56M to expand residencies through Existing programs could apply for $65,000 to add more residency slots MSUCOM and Detroit Health authority-$21m to start a community and hospital based residency for 85 Primary Care specialties in Detroit 68% of Residents stay in state where they trained ( residency > med school)

33 Not all Successful Florida- 5 new Medical Schools since 1997 FSU- applied for $3M; added rural rotations legislature approved; Governor vetoed Michigan- Governor s budget includes cut to Medicaid funding for GME-$163M (15% of all state and federal funding)

34 Summary Understand your GME Office Develop a business plan for your Residency Plan for alternative sources of funding Do not wait for the Government Be ready to show value of your training program

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