AAMC Teleconference on Medicare and ACGME Rules for Resident Supervision

Transcription

1 AAMC Teleconference on Medicare and ACGME Rules for Resident Supervision Presentation by Linda M. Famiglio, MD FAAP Chief Academic Officer, Geisinger Health System, Associate Dean, TUSM, September 21, 2011 Famiglio_Sept_

2 Residency is organized through accreditation requirements Accreditation Council for Graduate Medical Education acgme.org/acwebsite/dutyhours/dh_dutyhourscommonpr pdf American Osteopathic Association (AOA) is the accreditor for Osteopathic residency programs; similar requirements are published. Each sponsoring institution and each accredited program within the institution must demonstrate substantial compliance. ACGME CPR effective July 1, 2011 Famiglio_Sept_

3 What is a residency? Residency is an essential dimension of the transformation of the medical student to the independent practitioner along the continuum of medical education. ACGME CPR effective July 1, 2011 Residency: A program accredited to provide a structured educational experience designed to conform to the Program Requirements of a particular specialty. ACGME Glossary June 28, Famiglio_Sept_

4 What is a resident? Residency is an essential dimension of the transformation of the medical student to the independent practitioner along the continuum of medical education. ACGME CPR effective July 1, 2011 Medical Student PRE-RESIDENCY Has not yet graduated from an LCME or AOA accredited medical school Can not prescribe medications or procedures Participates in care delivery as part of their structured education Can not bill Famiglio_Sept_

5 What is a resident? Residency is an essential dimension of the transformation of the medical student to the independent practitioner along the continuum of medical education. ACGME CPR effective July 1, 2011 Resident Post - MEDICAL SCHOOL Has graduated from school Can prescribe medications or procedures Develops competency, in a progressive continuum towards independent practice Participates in care delivery as part of their structured education Can not bill Famiglio_Sept_

6 What is a resident? Any physician in an accredited graduate medical education program Often with a state-based restricted or training license The term Resident includes Interns Residents in their first year Aka PGY-1, R-1. Transitional year, Traditional Rotating Osteopathic Interns Residents Fellows Famiglio_Sept_

7 Some modifiers of Resident Categorical Resident: Resident who enters a program with the objective of completing the entire program. This type of resident is an accredited resident. Preliminary Resident: Resident who is completing prerequisites for a specialty residency or who has not yet been accepted into a specialty residency. This type of resident is an accredited resident. Chief Resident: Takes various forms- Position in the final accredited year of residency Or in the non accredited year after the residency is completed (Medicine, Pediatrics), more like a non accredited fellow Famiglio_Sept_

8 Fellow deserves further description Fellow: A physician in a program of GME accredited by the ACGME, AOA or the ABMS (American Board of Medical Specialties) Who has completed the requirements for eligibility for first board certification in the specialty Some also use the term subspecialty residents Famiglio_Sept_

9 Fellow deserves further description Modifiers can add precision and clarity Research fellow IMPLIES the fellow is NOT in an accredited program but rather is assigned full time to research Non-accredited or Non Standard fellow The fellow is in training of some sort, but the training program is NOT an accredited one This has implications for Medicare cost report as well as supervision requirements Accredited fellow = Resident for our purposes Famiglio_Sept_

10 More about Fellows Once specific state licensing requirements have been completed, fellows may be eligible for two concurrent roles 1. Accredited Fellow: Inside the structured, accredited educational program 2. Moonlighting as an Attending, Junior faculty or independent physician: Outside the scope of the educational program Generally requires unrestricted license Third party payer credentialing often must occur Famiglio_Sept_

11 How is supervision defined?... graded and progressive responsibility is one of the core tenets of American graduate medical education. Supervision in the setting of graduate medical education has the goals of assuring the provision of safe and effective care to the individual patient assuring each resident s development of the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine Famiglio_Sept_ ACGME CPR effective July 1, 2011

12 3 Goals of resident supervision 1. Patients must be safe and provided with quality care today And after the resident graduates 3. Residents must be educated in a humanistic environment where faculty model and residents demonstrate professionalism and effacement of self-interest. Nasca, AAMC Reporter, Sept 2010 Famiglio_Sept_

13 Regulation versus Professionalism At what level does monitoring of supervision occur? Institutional leadership/dio level Regulation Program Director Professionalism Individual Faculty Famiglio_Sept_

14 Supervision May be exercised through a variety of methods. Some activities require physical presence of the supervisor. The supervisor may be a more advanced resident Other activities can be adequately supervised by the immediate availability of the supervisor Available in the institution, or by telephone and/or electronic modalities. In some circumstances, supervision may include post-hoc review of resident delivered care with feedback as to the appropriateness of that care. Famiglio_Sept_

15 Definitions of Supervision Direct supervising physician is physically present with the resident and patient. Indirect with direct supervision immediately available supervising physician is physically within the site of patient care, and is immediately available to provide Direct. Indirect Supervision with direct supervision available supervising physician is not physically present within the site of patient care, but is immediately available by means of telephone and/or electronic modalities, and is available to provide Direct Supervision. Oversight supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered. Famiglio_Sept_

16 How does hospital-based faculty supervision of residents occur? Predominantly indirect supervision, with direct supervision immediately available AM rounds Daily huddles to run the list Phone calls to review specific events (admit, transfer, RRT) Direct supervision Presence during invasive procedures, 9/11 moments, admission and discharge Senior resident to junior for H&P, Assessments, Orders Famiglio_Sept_

17 Some supervision specifics PGY-1 residents must be supervised during all patient care activities: either directly or indirectly with direct supervision immediately available Continuity Clinic Setting for a longitudinal experience in which residents develop a continuous, long-term therapeutic relationship with a panel of patients. In Family Medicine: at least one supervising family physician freed of all other activities for every four residents If only one resident, a single faculty member may be engaged in other activities to a maximum of 50% Famiglio_Sept_