Teaching Health Center Graduate Medical Education Program: Two Year Update
American Association of Medical Colleges2013 9th Annual Physician Workforce
Research ConferenceSonghai Barclift, MD, FACOG
Branch ChiefBureau of Health Professions/Medicine and Dentistry
Health Resources and Services AdministrationDepartment of Health and Human Services
Objective
• Summary of the THCGME program• Major Growth Areas and Characteristics of
Current THCs• Highlight Innovations• Next Steps
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• THC model has a long history with several successful THCs dating back to the 1980s (Engebretsen 1989, Zweifler 1993)
• Increased likelihood of THC graduates choosing to practice in HCs/other underserved settings (Morris 2008, Reiselbach 2010)
• June 2010 MedPAC report
• Increase GME time spent in non-hospital settings
• Community-based care• Increase diversity
Sec. 5508 Affordable Care Act“Increasing Teaching Capacity”directed 230 million dollars over
5 years for the THCGME program
Components:• Section 338C(a), “National
Health Service Corps Teaching Capacity”
• Section 340H (Title III), “Payments to Qualified Teaching Health Centers”
Background THCGME Legislation
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Eligibility Criteria for THCGME
1• Community-based entity
2• Primary care residency
3• Institutional sponsor
4• New or expanded residency
5• Eligible residents
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What is a Community- Based Entity?
1. “Community-based ambulatory patient care center” that:
Operates a primary care residency program-FQHCs/FQHC Look-Alikes-Community mental health clinics-Rural health clinics-IHS or tribal health centers-Title X clinics
OR
Has collaborated to form an accredited GME consortium that operates a primary care residency program
1• Community-based entity
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Institutional Sponsor
3. Institutional sponsorshipMust be listed as institutional sponsor by relevant accrediting
body (e.g. ACGME, AOA, or CODA)Must be accredited or provisionally accredited at time of
applicationTeaching hospitals/academic institutions holding institutional
sponsorship are not eligible for THCGME funding
3• Institutional sponsor
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Traditional GME Model
Community Training Site
Teaching Hospital/ Academic Health
Center (inpatient)
Residency Program(continuity clinic)
Medicare GME $
Accreditation
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THC ModelCommunity
Training Sites
Hospital/ AHC
Medicare GME $
HRSA GME $Accreditation
Teaching HealthCenter
Residency
CHC
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THC Consortium Example
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THCGME Payment Model includes Accountability for Outcome Reporting
• THCs have to report on outcomes OR• Face possible 25% reduction in payment
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THCGME Growth
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FY 11
FY 12
FY 13
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
ApprovedProvisional ApprovalExisting ExpansionIneligible
Teaching Health Center Application Success
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Approved THC sites
HRSA Teaching Health Centers
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Growth of THCs within FQHCs
• 74% of THCs have FQHC affiliation
• 32% of FQHC affiliated THCs are sponsored by Health Centers vs. 8% prior to funding
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Family MedicineInternal MedicineDentalPsychiatryPediatricsOB/GYNGeriatrics
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Types of Residency Programs
Source: HRSA THCGME application data
Difficult to Reach Populations
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71%
Mental/Psych
45%
Substance Abuse
37%
Homeless
Source: HRSA THCGME application data
Increasing Access
32%
School-Based Clinics
58%
Geriatrics
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Source: HRSA THCGME application data
Teaching Health Center Profile
45%
Team-Based Care
34%
PCMH
71%
MUA/HPSA
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Source: HRSA THCGME application data
Innovations
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Innovations in Training
Wright Center for GME-AT Still University of Health Science’s School of Osteopathic Medicine collaboration
•“…address national physician workforce shortage by empowering these communities to steward their workforce renewal”
•Six FQHCs29 FM positions
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• Innovations in Accreditation• 2-2-2 Family Medicine • “You must be the change you want to see in the world”-Ghandi
Mercy Medical Center Graduates currently working at SCHC
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• Spanish Immersion
• All 8 graduates of the first class will continue in a community based underserved setting
“…emphasizes the cultivation of future safety net healthcare leaders”
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Next Steps
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Non-CHC vs. CHC trained Residents Working in Underserved Settings
NHSCHPSA
MHC*
IHS*
RHC*M
UA*CHC*
0%5%
10%15%20%25%30%
Non-CHC CHC
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Morris et al., Fam Med 2008; 40(4)
Telling the complete THC story
George Washington University Evaluation/BHPR Performance Measures
•THCGME distinguished characteristics
•Cost of training in a community based settings
•Long-term Impact on the Workforce
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Contact Information
Songhai Barclift, MD., FACOGChief, Community Based Training BranchDivision of Medicine and DentistryHRSA/Bureau of Health [email protected]
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