Transcript Slide 1

Educational Health Centers
Teaching Health Centers
April 3, 2011
Roxanne Fahrenwald MD
Kevin Murray MD
Mike Maples MD
What IS a Community Health
Center Anyway
Roxanne Fahrenwald, MD
Senior VP Educational and Clinical Services
RiverStone Health
Residency and Fellowship Director
Montana Family Medicine Residency and Sports Medicine Fellowship
RPS Consultant
[email protected]
Moses Maimonides
12th Century CE
“Do not allow thirst for profit, ambition for
renown and admiration, to interfere with my
profession, for these are the enemies of truth
and of love for mankind, and they can lead
astray in the great task of attending to the
welfare of thy creatures.”
Maimonides
CHC’s - Origin
• Civil Rights / Social Justice Movement
– Recognition of health disparities and
community/public health needs
• First Health Center – Mississippi 1965
• Growth paralleled the emergence of Family
Medicine specialty
– Similar social drivers and goals: healthcare for all
CHC’s Now
• 1200 health centers
• 7000 delivery sites
• 18 million patients and 63 million
encounters per year
• 70% of CHC patients live in poverty
• Estimated to save the US health care
system $9.9B - $17.6 Billion annually
Who Is Served in the CHC
Income
Ov e r
200% FPL,
8.6%
100% FPL
and
Be low,
70.4%
151-200%
FPL 6.7%
101-150%
FPL 14.3%
Insurance sources for those served in
the CHC
Medicare,
7.6%
Private,
15.5%
Other
Public,
2.6%
Uninsured,
38.9%
Medicaid,
35.4%
Health Center National Outcomes
• Diabetic pts – higher rates of eye exams,
foot exams, flu shots and Pneumovax
• Uninsured and Medicaid patients receive
more health promotion counseling
• Lower rates of low birth weight babies
• Reduced disparities in access to:
– Mammograms and PAP testing
Service
“Preserve the strength of
my body and of my soul
that they ever be ready
to cheerfully help and
support rich and poor,
good and bad, enemy as
well as friend. In the
sufferer let me see only
the human being.”
Education
“Let me be contented in
everything except in the
great science of my
profession. Never allow
the thought to arise in me
that I have attained to
sufficient knowledge …for
art is great but the mind
of man is ever expanding.”
Maimonides
Health Centers Have Requirements
• Serve high need community
– HPSA, Medically Underserved Area (MUA) or Medically
Underserved Population (MUP)
• Provision of comprehensive primary & preventive
care and enabling services (education, translation,
transportation)
• Services available to all
– fees based on ability to pay
• Governed by a consumer majority Board minimum 51% patients, rest represents community
Requirements
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Hospital Privileges or equivalent
Continuum of Care
QI Program
Program data reporting systems – annually
submit “UDS” Uniform Data System report
• Accessible hours
• Regs may specify what providers are billable,
services allowable
FQHC/CHC Covered Providers
and Services
• Influenced by state Medicaid requirements and
federal regulations
• Complex and sometimes non-intuitive list
Why be a Health Center?
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Serve medically disenfranchised
Federal grant for sliding fee scale offset
Cost based Medicare/Medicaid reimbursement
“340B” Drug Program
Federal Tort Claims Act (FTCA) instead of
traditional liability insurance
What do patients pay?
• Medicare – the usual coinsurance (options)
• Medicaid – may have copayment
• Uninsured – SFS amount plus labs -- based on
income/ FPL
• Individual CHC Board input into the SFS
HOW CAN I USE THIS MODEL
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Teaching Health Centers only one model
Many of us taught in CHCs before this
Many opportunities for models
EHCI provides tools and assistance
RPS consultants have experience
ACGME exceptions for CHC
• PD control over educational activities –
signed agreement with CHC board
– Appointment and assignment of faculty
preceptors
• Admit patients and have continuity
• CHC must have all required areas and staff
incuding BH, lab and imaging access. RRC
decides if adequate
Funding - Diversifies Opportunity
• Service:
– Sliding Fee Scale grant “330”, expansion and service grants,
health care for homeless grants
– Fee for service – self pay and private insurance
– Cost based Medicare and Medicaid
– FTCA liability insurance
• Education:
– GME through the hospitals, potentially DME can go to CHC
– Residency targeted grants: training and equipment
– Student program funding: AHEC, University programs
• Both
– Teaching Health Center funding
Residency : Advantages of the CHC
• A plethora of patients
– Endless medical need
– Experience with resource management
• Attract physicians as faculty who understand service
in medicine
• Solid model for rural and frontier care
• Access to funding stream for uninsured patient care
support
• Attraction of residents with “the right stuff”
The Right Stuff
Maimonides, 12th century CE
“May the love for my art
actuate me at all times;
may neither avarice nor
miserliness, nor thirst for
glory or for a great
reputation engage my
mind; for the enemies of
truth and philanthropy
could easily deceive me
and make me forgetful of
my lofty aim of doing
good…”
“Grant me the strength,
time and opportunity
always to correct what I
have acquired, always to
extend its domain; for
knowledge is immense and
the spirit of man can
extend indefinitely to
enrich itself daily with new
requirements.”
Teaching Health Centers:
thinking strategically
Mike Maples, MD
CEO
CHCW
Yakima, WA
[email protected]
For AAFP/RPS: April 3, 2011
Round 1 History
• Funding opportunity timeline
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Nov. 29, 2010: Guidance Issued
Dec. 30, 2010: Application Deadline
Jan. 25, 2011: Funding Awards Announced
~July 1, 2011: THC funded residents start
training
Round 1 Awards
• Applications
– 23 completed applications
• Awards
– Eleven awards
• Primarily funding expansion of existing programs
– 8 programs; 22 R1 positions/yr
• Two “conversions”
– One established, full conversion, with expansion (9 + 1), 10 R1
positions/yr
– One full conversion of new in 2010 program: 8 R1 positions/yr
• One NEW program
– W. Va.: 4 R1 positions/yr
Round 1 Outcome Summary
• Total R1 positions/yr funded or created
– 44
• FFY 2011 awards announced
– $1.9M
• Funds Committed
– 25-30 % (of the $230M appropriation)
….do the math
• CHCW/Yakima, WA example: 2 residents per
year expansion
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NGA amount = $75,000
NGA initial period = 7/1/11 – 9/30/11
Annualized for first year (x4) = $300,000
If renewed for
• Year 2 (4 funded residents)=$600,000
• Year 3-5 (6 funded residents)= $900K x 3=$2.7M
– Total potential commitment=$3.6M
THC Potential
• Assuming that the current appropriation of
$230M over 5 years survives….
• Likely to fund a maximum of 130-160 THC
positions per year (relative to ~3,000 Fam
Med R1 positions offered annually)
• Advocacy for expanded funding
THC as “Demonstration” Project
• Define the outcomes
• Measure the outcomes
• Can we?
– Very few “pure” THC residents to be measured
– Contaminated by history and hybridization
• Do we need to?
– Ample data currently available to demonstrate that the
community-based training model works!
THC Decision Making
• Major commitment to be in a position to
apply
– “Community-based” agency must be the
accredited agency
• Highly competitive
– Plan B?
• Current funding expires 2016 (? Sooner)
THC Competitive Strategy
• Competitive advantages
– Clear and direct payment to the community-based
accredited agency/teaching program
– Compliance
– Merit
• ? Funding Preferences
• ? Distribution of funding
– Geographic
– Specialty
– Other…
THC Timeline: round 2
• Renewal
– Summer
• New funding awards
– Fall
• May be concurrent
THC Guidance: round 2
• Award amount
– Direct Expense
– Indirect Expense
• New legislation to change rules
Becoming a Teaching Health Center
-A compass to help navigate the system
Kevin Murray, MD
Medical Director, Faculty Division,
MultiCare Medical Associates, MultiCare Health System
Former Program Director, Tacoma Family Medicine
Tacoma Washington
Resources
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Existing legislation
Local Health Center
RPS
NACHC
Existing residencies in HCs
EHCI
EHCI brief progression
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Formed from concern about FM residency stabilization needs and HCs
workforce challenges in 2004 in WWAMI.
Grew to collaborative group of UWSOM; UW Dept of Family Med; Network
FM program directors; NWRPCA;CHAMPS. Mainly volunteer effort
Relationship; design and content; advocacy
Input to HRSA
Development of materials to assist exploration and creation of THCs
Developing consultation services now
Funding expired
EHCI??
• Educational Health Center Initiative was name we
gave ourselves in early stages.
• Website developed with that name
• Legislation created name and they didn’t ask us!
• EHCI meant to address more than just
residencies in scope of med ed. and health
centers
EHCI Spectrum
• Heavily influenced by collaboration with HCs and their needs
nursing, dentistry, other
• Also influenced by political advocacy/lobbying realities
• Education of various clinical disciplines
social workers, nurses, dentists, pharmacists, etc
• Education of various medical specialties
Mainly primary care, but psychiatry is also big need
• Education of varied time and administrative commitment:
Occasional rotation, fixed rotation, FMC, sponsor residency
Toolkit
• Developed with funding from Macy Foundation.
• Intended as a public domain set of materials with
ongoing revision
• Want feedback to improve or correct it
• Present on website with additional materials
related to THC.
• Will visit now
Homepage of EHCI
http://www.teachinghealthcenter.org/
Conclusion
• One more location for information
• Contacting current new THC’s
• Collaborate by sharing experience and learning for
augmentation the website
• EHCI currently forming technical advisory consulting
capacity. Contact us if wish to learn more about this.
• What resources have you found helpful to share with
your colleagues here?
• Thanks
Questions?