Would an Osteopathic Residency Program Benefit My Hospital?

Overview

 Why you should consider Graduate Medical Education?

 Why the AOA is interested in helping you start a GME program?

 The basics: The relationship between medical schools, Graduate Medical Education and hospitals  Is your hospital a good “fit” for GME?

 Costs, reimbursement and non-monetary benefits of sponsoring Graduate Medical Education  Next steps

Why You Should Consider GME in Your Hospital  A Growing National Issue – Need for primary care providers – Insufficient residency training positions  Your hospital, medical staff and community will benefit

• • • • Increasing Need for Primary Care Providers Aging physician workforce Imbalance of specialty-trained physicians compared to primary care physicians Projected increase in demand from health insurance mandate in Patient Protection and Affordable Care Act Accountable Care Organizations will enhance the demand for primary care physicians to coordinate and manage patient care

Insufficient Residency Training Positions  Increased number of AOA COM’s  Increased number of COM graduates  Increased number of allopathic medical school graduates  Steady inflow of IMG’s  Inadequate number of residency positions for all of the graduates/potential graduates

Benefits of GME

• • • • • Hospital Benefits Medical Staff Benefits Recruiting Benefits Patient Care Benefits Bottom Line Benefits

Overview

 Why you should consider Graduate Medical Education?



Why the AOA is interested in helping you start a GME program?

 The basics: The relationship between medical schools, Graduate Medical Education and hospitals  Is your hospital a good “fit” for GME?

 Costs, reimbursement and non-monetary benefits of sponsoring Graduate Medical Education  Next steps

Why the AOA is Interested

• • • • The number of Osteopathic Colleges of Medicine has increased from 17 COM’s ten years ago to 29 COM’s offering study in 37 locations today The number of osteopathic medical school graduates has increased from 2500 ten years ago to a projected 5600+ by 2015 The number of graduates from allopathic medical schools is also increasing Bottom Line: The AOA wants to ensure that graduates of osteopathic colleges of medicine will have the opportunity to go to a residency training program in this country

The AOA

• • • Professional Association Representing 78,000 Osteopathic Physicians & >20,000 Medical Students Primary Certifying Body for DOs Accrediting Agency for Osteopathic GME, Colleges of Osteopathic Medicine, Hospitals & Other Health Care Facilities

Osteopathic Medicine

• • Founded in 1874 by Andrew Taylor Still, MD, DO Focused on the Whole Person - Unity of Mind, Body, Spirit - Structure Influences Function - Innate Ability of the Body to Health Itself

Osteopathic GME

• • • • Primary Care Focus + 23 Medical Specialties Community-Based Clinical Education 1 in 5 Medical Students attends 1 of 29 Colleges of Osteopathic Medicine in 37 Locations Osteopathic Medicine is One of the Fastest Growing Health Professions

OGME Development Initiative

A Ready Source of Information and Expert Assistance for Starting an Osteopathic Graduate Medical Education Program in Your Hospital

Trends Affecting Hospitals

• • • • Physician Workforce Shortages New Colleges of Osteopathic Medicine & Medical Schools Increasing Number of Medical Graduates Increased Interest in Starting GME Programs

= New Hospital Opportunities

Overview

 Why you should consider Graduate Medical Education?

 Why the AOA is interested in helping you start a GME program?



The basics: The relationship between medical schools, Graduate Medical Education and hospitals

 Is your hospital a good “fit” for GME?

 Costs, reimbursement and non-monetary benefits of sponsoring Graduate Medical Education  Next steps

Training to Be a Physician

• • • • College graduate Medical school (4 years) – Allopathic (M.D.) – Osteopathic (D.O.) Postgraduate training (GME) – Residency (3-5 years) – Fellowship (1-2 years for subspecialty training) – Both the AOA and the ACGME independently approve GME programs CME (Continuing Medical Education) – Annual requirement of 50-100 hours of medical education courses

• • •

Medical Education and Hospitals

Medical School (Traditional Model) – First two years: on campus – Third & Fourth year: In hospital or outpatient setting on rotation Graduate Medical Education (Residency) – 3+ years depending on specialty – Funding is hospital-based Fellowships – 1+ years for subspecialty training – Funding is hospital-based (usually large teaching hospitals)

How Does a Hospital Support Medical Students?

 Liaison with medical school  Arrange/Facilitate student rotations with medical staff  Administrative support  “Home Base” for the year, but students still “belong” to their medical school

• • • How Does a Hospital Support a Medical Residency? Residents are hospital employees – Salary and benefits Hospital provides training infrastructure – Program accreditation – Employs Director of Medical Education, Program Directors, administrative staff – Coordinates faculty – Provides facilities and other support Residents provide patient care

Residents Provide Services

• • • • • • • Year 1 Year 2 Year 3 Inpatient rotations Inpatient coverage Outpatient clinics – Continuity clinic – – Community benefit clinics Specialty clinics Supervise other residents

Who Pays for Medical Education?

 Medical/osteopathic school- the student pays tuition – $20-50K per year for 4 years – Most students have debts upon graduation – 93% in debt (average for those > $200K)  Residency & Fellowship- Medicare reimburses hospitals for direct and indirect costs of residency training.

 CME- self or employer paid

Overview

 Why you should consider Graduate Medical Education?

 Why the AOA is interested in helping you start a GME program?

 The basics: The relationship between medical schools, Graduate Medical Education and hospitals 

Is your hospital a good “fit” for GME?

 Costs, reimbursement and non-monetary benefits of sponsoring Graduate Medical Education  Next steps

Criteria for a Good “Fit”

 General guidelines: Few specific Pass or Fail criteria  Funding requisite: meet Medicare criteria for reimbursement  Educational requisite: support of – Medical staff – Hospital leadership  You will need a “Physician Champion”

Medicare Criteria for Reimbursement • Balanced Budget Act of 1997 – Hospitals which were conducting GME residency training at that time are capped at that number of residents for reimbursement purposes – If a hospital residency count falls below that number, the new lower number of residents becomes the new cap

FTE Cap

• • • Hospitals will only be reimbursed by Medicare for APPROVED positions The Medicare FTE Cap establishes a limit on the number of trainees which Medicare will reimburse

Cap Necessitates Advance Planning & a Strategic Approach to Developing a GME Program

“New” Teaching Hospital

• • • • Hospital with a GME Program Established On or After January 1, 1995 Resident “Cap” is Set Based on the Number of Residents in All Specialty Programs in the Third Year After Training Begins Once Caps are Set, Urban Hospitals Generally Cannot Add Medicare-Funded Positions Rural Hospitals Can Add New Specialties but Cannot Expand Existing Programs

Medical Staff Support is Critical

 Willingness to participate in an educational environment – Teaching, sharing and scrutiny  Willingness to work with residents  Willingness to sponsor medical students, and  The time to act upon this willingness

Other Criteria for a Good “Fit”

 Sufficient inpatient and outpatient volume – “Sufficient” depends on which GME programs are to be started  Higher percentage of Medicare (both FFS and Medicare Advantage) patients is better

Overview

 Why you should consider Graduate Medical Education?

 Why the AOA is interested in helping you start a GME program?

 The basics: The relationship between medical schools, Graduate Medical Education and hospitals  Is your hospital a good “fit” for GME?



Costs, reimbursement and non-monetary benefits of sponsoring Graduate Medical Education

 Next steps

A Word about Costs

• • • Start-Up Costs Include: Resident Salaries & Benefits Faculty Salaries - DME & Program Director(s) - Inpatient & Ambulatory Teaching Faculty - Support Staff Capital & Equipment Costs (call rooms, library, computers, intern/resident lounge)

A Word about Payment

 Medicare pays teaching hospitals – Direct Graduate Medical Education (DGME) Payments – Indirect Medical Education (IME) Adjustment 

Based on Formulas, Statutory Factors & Certain Hospital-Specific Data

DGME Payment

• • Payment for Medicare’s Share of the Costs of Training Interns & Residents - Resident Salaries & Benefits - Faculty Compensation - Program Administration & Overhead Costs Calculated using Hospital-Specific Per Resident Amount, Medicare Utilization Rate & Number of Full Time Equivalent Residents

IME Adjustment

• • Recognizes Teaching Hospitals Have Higher Patient Care Costs due to Presence of Trainees - Treating Sicker Patients - Offering More Services, Tests & Technology Calculated using Hospital-Specific Teaching Intensity (ratio of residents to beds), DRG Payments and Statutory IME Adjustment Factor for the Current Year

Costs: Medical Students

• • • You will have some costs for medical students – Costs for medical students are not reimbursable Why support medical students? – Some of them will become your residents – Excellent recruiting mechanism – Opportunity to evaluate potential residents What costs might I have?

– Administrative support – Many hospitals provide meals – Some hospitals provide lodging

What Are the Real Benefits of Sponsoring GME?

 Benefits to hospital  Benefits to medical staff  Benefits to patient care  Benefits to recruiting program  Benefit to hospital bottom line

Hospital Benefits

• • • • • • • Physician Recruitment Culture of Education In-House Physician Coverage Educational & Technical Expertise Enhanced Service to the Community Competitive Advantage Revenue Stream

Medical Staff Benefits

• • • • • • • Environment of Life-Long Learning Expanded Referral Network Prestige in the Community Tighter Bonds Among Medical Staff & Among Attendings, House Staff & Nursing Enhanced CME Opportunities Succession Planning Mentoring and Molding Future Physicians

More about Osteopathic Physicians

 Approximately 60% of practicing osteopathic physicians practice in the primary care specialties of family medicine, general internal medicine, pediatrics, and obstetrics and gynecology.

 Many DO’s fill a critical need for physicians by practicing in rural and other medically underserved communities.

Recruiting Benefits

• • • • • Ability to “Grow Your Own” Medical Staff Reduced Physician Recruiting Expenses Caliber of Training is a Known Quantity Trainees are Already Known & At Home in the Community Interns & Residents Tend to Remain in the Area Where They Train

Patient Care Benefits

• • • • • • • • Access to Care Enhanced Coverage & Quality Enhanced Ability to Meet Community Needs Expanded Scope of Services Presence of Residents 24/7 More Patient Contact with Physicians Increased Comfort Level for Nursing Opportunity for Clinical Trials & Research

Bottom Line Benefits

• • • • Medicare Direct & Indirect GME Payments Reduced Medical Staff Coverage Expenses Increase in Physician Referral Base Financial Support also may be available from Medicaid, the Veterans Administration and Other Federal or State Programs

Overview

 Why you should consider Graduate Medical Education?

 Why the AOA is interested in helping you start a GME program?

 The basics: The relationship between medical schools, Graduate Medical Education and hospitals  Is your hospital a good “fit” for GME?

 Costs, reimbursement and non-monetary benefits of sponsoring Graduate Medical Education 

Next steps

What Keeps CEOs Up at Night

• • • • • • Competition for Well-Reimbursed Patient Services Increased Cost of Physician Services Emphasis on Cost Containment Quality Oversight/Ties to Payment Shortage of Skilled Healthcare Workers Shortage of Physicians – Especially Primary Care Physicians

How will an Osteopathic Graduate Medical Education program fit into your hospital’s Strategic Plan?

• •

Some Strategic Considerations

Your mission: Why does your hospital exist?

– Patient Care & Physician Services?

– Service to the Community?

– Quality & Safety?

– Education?

– Research?

Your vision: What image in your community do you wish to portray as you fulfill your mission?

Some Strategic Considerations

 Your values: What are the guiding principles that drive your work?

– Planning for the future?

– Improving Community Health?

– Providing Care for Those in Need?

– Providing a Resource for Physicians?

Some Strategic Considerations

 Your competitive position: How would GME affect your SWOT analysis?

– Build on Internal Strengths – Fix Internal Weaknesses – Take advantage of External Opportunities – Counter External Threats

“OK, you convinced me. When do I start?”

Next Steps

 The approval process  How AOA can help

The Approval Process

 OPTI (Osteopathic Postgraduate Training Institution)  AOA approvals  CMS Fiscal Intermediary

Osteopathic Postgraduate Training Institution (OPTI)  Osteopathic graduate medical education (OGME) programs differ from allopathic training programs  To foster collaboration in OGME’s predominately community-based training programs, the AOA initiated OPTI’s in 2000  Every hospital offering OGME programs belongs to an OPTI – Academic sponsorship – Program support

More on OPTI’s

 Every OPTI is affiliated with an osteopathic school of medicine  OPTI’s vary in scope of services provided – Some OPTI’s provide extensive services, such as web-based instruction – Others provide fewer services – All OPTI’s will assist you through the AOA program approval process  You will have your choice of OPTI’s

OGME Development Initiative

Marshalls the Resources of the AOA & the Osteopathic Profession to Help Hospitals Interested in Starting New Osteopathic GME Programs

OGME Development Initiative

Employs –

• • • A Strategic Approach Expert Consultants Useful Materials on Starting and Operating High Quality OGME Programs

OGME Development Initiative

• • • •

Answers such Practical Questions as –

What are the Benefits of an OGME Program?

What Assistance & Information are Available?

How to Move Forward from Interest to Program Approval?

Where to Call for Complimentary In-Person Assistance from Experienced Consultants?

OGME Development Initiative

• •

Provides Support to Assist You in –

Adding an OGME Program to Your Hospital’s Strategic Plan Reaping the Benefits of an OGME Program - To the Hospital - To Patients - To the Community - To the Medical Staff

Knowledgeable Consultants

Initiative Corps of Consultants includes

• Seasoned Teaching Hospital CEOs & Senior Administrative Staff, Directors of Medical Education, Deans, Program Directors & Other Medical Educators

Knowledgeable Consultants

• • • • •

Provide Peer-to-Peer Assistance, by Conference Call & On Site, to -

Answer Your Questions Work One-on-One with Colleagues Share their Expertise & Experience Estimate Start-Up Costs & Medicare Payment Guide You Through the Accreditation Process

Knowledgeable Consultants

• • • • • • •

Help You Identify the Keys to Success –

Local Champions Physician Leadership Medical Staff Hospital & System Administration Hospital & System Boards The Community OPTIs

Knowledgeable Consultants

• • • • •

Focus on Critical Components -

Faculty Resources Community Needs Adequate Medicare Percentage for Reasonable Payment Sufficient Patient Load Scope, Variety & Volume of Trainee Experiences

Information & Materials

• • • • •

Provide You with Easy Access to Web-Based Resources on –

Medicare Financing Program Approval & Accreditation Educational Standards & Policies Physician, Hospital & Trainee Agreements Templates, Models & Forms Designed to Help Smooth Your Way to a Quality Program

For Further Information

OGME Development Initiative (800) 621-1773, ext. 8010 [email protected]