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

Overview






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






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






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






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






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?


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?


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


Marshalls the Resources of the AOA & the Osteopathic

Profession to Help Hospitals Interested in Starting New Osteopathic GME Programs


Employs –

• A Strategic Approach• Expert Consultants• Useful Materials on Starting and

Operating High Quality OGME Programs


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?


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


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


Help You Identify the Keys to Success –

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


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]

Would an Osteopathic Residency Program Benefit My Hospital?

Documents

patient care slide

osteopathic physicians

benefits patient care

allopathic medical schools

osteopathic residency

primary care physicians

medical specialties

locations osteopathic