Transcript There is no such things as Protected Time

Financing a DOM:
The Funding of Academic
Departments of Medicine
DRAFT
Robert W. Finberg, MD
Chair, Department of Medicine
University of Massachusetts Medical School
Thomas Gakis
AVP & CAO, Departments of Medicine,
Neurology and Surgical Services
University of Massachusetts Medical School
Outline
• Sources of Funds
– Allocation of Funds
• Uses of Funds – Components
• Mission Based Profit & Loss
• What if…
– Scenarios and Discussion
Sources & Uses of Funds:
The Witches Caldron
Sources of Funds
UMass DOM
Hospital Sources
•
•
•
Administrative Stipends: Chairs,
Vice Chair, Chiefs, Medical
Directors, Quality Officers
Program Investments: Funds
Flow from Med Ctr to Med Group
to fund market competitive
compensation plans
GME : From Medicare Education
Pay’ts to Med Ctr.
School Sources
•
•
Research Salary Support, UME,
and Administration via
Appropriations
Research Trust Funds: Based on
% of Indirects generated
So, you’ve seen one AMC…
Faculty Salaries by Source
Hospital
Practice Plan
School (incl. Dean/State)
Research Grants
VAMC
Other
Grand Total
U Mass
20%
55%
10%
14%
0%
0%
Kentucky
32%
18%
15%
10%
20%
5%
Albany
12%
71%
0%
7%
5%
5%
So. Illinois
22%
44%
33%
1%
0%
0%
JHU
23%
22%
2%
44%
0%
9%
Yale
12%
17%
2%
48%
18%
3%
U Pitt
5%
44%
4%
46%
0%
1%
100%
100%
100%
100%
100%
100%
100%
Source: Alliance for Academic Internal Medicine, 2008 Survey – Faculty Salary Data
Allocations of Funds
• Administrative Stipends:
– Based on Time & Effort, % fully loaded FTE, exclusive of overhead
• Program Investments:
– % Contribution Margin to Medical Center, or Fixed Investment, or
budgeted bottom line support, etc.
• GME:
– Use of Hunter Group Allocation Methodology
• UME:
– Use of Educational Effort Assignment Task Force (EEATF)
Recommendations (Leadership, Practice, Classroom)
• Research Trust Funds:
– Based on % of indirect revenue generation
GME Teaching Allocation
FY 2015 Teaching Allocation
Draft-FINALE.
By Program as of 7/1/2014 Updated
FY2015
6/10/2014
PRINT LEGAL PAPER
Program
Category
MEDICINE
Primary
MED PEDS
Primary
PULMONARY
Specialty
INFECTIOUS DISEASE Specialty
HEMATOLOGY/ONCOLOGY
Specialty
GASTROENTEROLOGY Specialty
CARDIOLOGY
Specialty
RHEUMATOLOGY
Specialty
GERIATRIC
Specialty
RENAL (Nephrology)
Specialty
ENDOCRINOLOGY
Specialty
DERMATOLOGY
Specialty
SUBTOTAL MEDICINE
F.
I.
Total
J.
I. / F.
OGME
# ResidentsDivision
Ratio and Fellows Factor
1: 6
92.00
15.3
1: 6
16.00
2.7
1: 12
9.00
0.8
1: 10
6.00
0.6
1: 12
9.00
0.8
1: 12
9.00
0.8
1: 12
21.00
1.8
1: 10
4.00
0.4
1: 10
2.00
0.2
1: 12
6.00
0.5
1: 10
3.00
0.3
1: 10
10.00
1.0
187.00
25.00
P.
J. x N.
Q.
Residency
R.
S.
Fellowship
T.
U.
V.
W.
FY 2015 DRAFT
= P. + R. + sum ( T. : V. ) Total
Factored
RRC
N. x Q.
EETF
N. x S. Program
= Y. x Total
Faculty Prog. Dir. Residency Prog. Dir. FellowshipComplexityProgram TOTAL-Prior
Salary
% Effort Stipend % Effort Stipend Stipend Assistants to Allocation
3,862,467 200.00% 503,800
50,000
80,000
4,496,267 2,072,759
459,556
50.00%
86,167
40,000
585,722
270,015
176,375
25.00%
58,792
235,167
108,411
110,940
25.00%
46,225
157,165
72,452
193,050
25.00%
64,350
257,400
118,660
252,700
25.00%
84,233
336,933
155,325
609,467
100.00% 348,267
957,733
441,511
75,627
25.00%
47,267
122,893
56,653
39,207
25.00%
49,008
88,215
40,667
105,650
25.00%
52,825
158,475
73,056
59,270
25.00%
49,392
108,662
50,093
360,600
25.00%
90,150
10.00%
36,060
40,000
526,810
242,857
6,304,907
680,117
836,418 50,000 160,000
8,031,442 3,702,459
UME: Educational Effort
Assignment Task Force
Category
Leadership
Practice
Classroom
Leadership
Classroom
Leadership
Leadership
Leadership
Leadership
Leadership
Practice
Practice
Practice
Practice
WTA
WTA
Course or Program
Effort Category
Doctoring Clinical Skills (DCS)
Small Group Leader
Doctoring Clinical Skills (DCS)
DCS-I Small Groups
Doctoring Clincal Skills
DCS-I Small Groups
Clinical Science Academic Evaluation Board
Academic
–
Evaluation Board Chair & EPC Co-Chairs
Doctoring Clinical Skills
DCS- I
Medicine Clerkship
Clerkship Assistant Director
Medicine Clerkship
Clerkship Site Director - Univ
Patients
Co-Leader
Medicine Clerkship
Longitudinal Preceptor of Medicine
Medicine Clerkship
Longitudinal Preceptor of Medicine
Medicine Clerkship
Ambulatory (July - Sept 2013)
Medicine Clerkship
Ambulatory
Medicine Clerkship
Ambulatory
Medicine Clerkship
Ambulatory
WTA (Non-revenue generating) - Memorial WTA
WTA (Non-revenue generating) - Memorial WTA
HR Department
Medicine
Medicine
Geriatrics
Geriatrics
Prev. Med
General Medicine
General Medicine
General Medicine
General Medicine
General Medicine
General Medicine
General Medicine
General Medicine
General Medicine
ID
Infectious Diseases
Uses of Funds
Uses of Funds
Function
Clinical - Fac S&W
School - Fac S&W
Faculty Salaries & Wages
FY09
$M
%
FY14
$M
%
50.0
15.6
65.6
46%
14%
60%
68.8 49%
17.8 13%
86.5 62%
Clinical - Staff S&W
Staff Salaries & Wages - School
Staff Salaries and Wages
13.3
13.1
26.4
12%
12%
24%
11.9 8%
13.3 9%
25.2 18%
Clinical Supplies/Opex
School Supplies/Opex
Supplies & Expense
4.7
8.4
13.1
4%
8%
12%
8.5 6%
12.1 9%
20.6 15%
Clinical Overhead
4.7
4%
8.1 6%
Mission
Research
Education
Clinical
109.8 100%
140.4 100%
36.6 33%
7.2 7%
66.0 60%
42.6 30%
8.0 6%
89.8 64%
•
•
•
•
Bases for salaries/compensation
utilize MGMA, AMGA, AAMC
benchmarks for compensation
and productivity
Staff includes midlevel providers
(clinical) and post doc students
(school)
Clinical Supplies/OPEX includes
practice based expenses (rent,
etc).
School Supplies/OPEX includes
payments for subaward
institutions.
Mission Based Profit & Loss
Mission
FY09
Sources Uses Margin
FY14
Sources Uses Margin
Research
37.2
36.6
0.6
41.4
42.6
(1.2)
Education
5.0
7.2
(2.2)
3.9
8.0
(4.1)
69.3
66.0
3.3
96.1
89.8
6.3
111.5
109.8
1.7
141.4
140.4
1.0
Clinical
Total
• NIH Reductions in
Funding Levels
• Reductions in
Funding for
Education
• Reductions in
Investments From
Medical Center
• Expectation in
Reduction of GME
Funding
What if…
( Scenarios for Discussion)
1. …NIH funding levels and/or salary caps do not return to
normative levels?
2. …Reductions in Investments and Administrative Stipends
From Medical Centers continue?
3. …Appropriations for Education are Reduced by Medical
Schools?
4. …IME (GME) funding is reduced by Congress?