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Would an Osteopathic Residency Program Benefit My Hospital?

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

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Would an Osteopathic Residency Program Benefit My Hospital?

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  1. Would an Osteopathic Residency Program Benefit My Hospital?

  2. 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

  3. 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

  4. 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

  5. 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

  6. Benefits of GME • Hospital Benefits • Medical Staff Benefits • Recruiting Benefits • Patient Care Benefits • Bottom Line Benefits

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. OGME Development Initiative A Ready Source of Information and Expert Assistance for Starting an Osteopathic Graduate Medical Education Program in Your Hospital

  13. 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

  14. 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

  15. 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

  16. 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)

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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”

  23. 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

  24. 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

  25. “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

  26. 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

  27. 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

  28. 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

  29. 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)

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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

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

  36. 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

  37. 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.

  38. 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

  39. 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

  40. 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

  41. 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

  42. 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

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

  44. 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?

  45. 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?

  46. 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

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

  48. Next Steps • The approval process • How AOA can help

  49. The Approval Process • OPTI (Osteopathic Postgraduate Training Institution) • AOA approvals • CMS Fiscal Intermediary

  50. 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

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