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 • 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

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

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

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

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

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

Would an Osteopathic Residency Program Benefit My Hospital?