UW MEDICINE │ 2015 Legislative Staff Tour

GME FUNDING:2015 LEGISLATIVE STAFF TOUR

AMITY NEUMEISTER, MBA, RYTASSISTANT DEAN, GRADUATE MEDICAL EDUCATION

AUGUST 11, 2015

• The UW GME Enterprise• How is GME funded nationally?

• CMS, HRSA, VA, THC• Detail on Medicare payments• UW Medicine GME funding

AGENDA

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• 101 ACGME, 2 ABOG & 4 CODA programs• 95+ non-accredited programs• ~1300 ACGME trainees at ~300 teaching sites• 100+ non-accredited clinical

fellows• 8th largest in # ACGME

trainees• 7th largest in # ACGME

programs

UW GME ENTERPRISE

UWMC402

Harborvie329

Children's218

VA165

Other241

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Funded Positions by Site

ACGME = Accreditation Council for Graduate Medical EducationABOG = American Board of Obstetrics & GynecologyCODA = Commission on Dental Accreditation

GME IN THE WWAMI REGION

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FMRN = 1 (36)Other = 1 (2)

UW = 100 (1294)*FMRN = 15 (337)Other = 35 (458)

FMRN = 2 (54)IM = 1 (30)Other = 1 (1)

FMRN = 2 (42)FMRN = 5 (87)UW IM = 1 (28)Other = 2 (2)

Updated 10.06.14*Includes the UW FMRN program (24 residents)

Average cost to train a resident=

$152,000+ per year

5Source: AAMC’s What Does Medicare Have to Do With Graduate Medical Education?

How is GME funded nationally?

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GME FUNDING SOURCES

ESTIMATED SOURCES OF $15 BILLION IN PUBLIC FUNDING FOR GME

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SOURCE: Institute of Medicine’s 2014 Report “Graduate Medical Education That Meets the Nation’s Health Needs” NOTE: Additional unreported funding comes from the Department of Defense, state sources, private insurers, and other private sources. a = data from 2012; b = data from 2011 and 2013.

• Single largest funder of GME nationally• Goal: To pay for Medicare’s share of GME

costs, based on portion of hospital expenses related to Medicare patients

• Covers: Direct & Indirect expenses through Medicare Cost Report

• Sites: Adult teaching hospitals and limited non-hospital sites

MEDICARE FUNDING

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• Medicaid payments in Alaska, Idaho Montana & Washington made under Fee-For-Service program

• Methodology varies by state (less than 5% of funding in WA)

MEDICAID FUNDING

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• Goal: To enhance the quality of care provided to Veterans

• Covers: Direct & Indirect costs through Disbursement Agreement & VERA payments

• Sites: 124 VA hospitals, CBOCs, IOCs, limited community-based outpatient clinics

VETERANS AFFAIRS (VA) FUNDING

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CBOCs: Community-based Outpatient Clinics, IOCs = Independent Outpatient Clinics,Direct: (resident stipends & fringe benefits), Indirect: (attending contributions, VA Program Administration, higher complexity care), VERA = Veterans Equitable Resource Allocation

• Goals: Enhance research capabilities & care for vulnerable and underserved children

• Covers: CHGME payments for Direct & Indirect GME expenses through annual initial & reconciliation application process

• Sites: 54 Children’s hospitals

HRSA FUNDING

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HRSA: Health Resources and Services Administration, CHGME: Children’s Hospitals GME, Direct expenses = stipends for residents, salaries, salaries for faculty, overhead, Indirect expenses = reduced productivity and clinical inefficiencies

• $230 million, 5-year ACA initiative to increase primary care residents in community-based settings

• Goals: Increase access to the geographically isolated, economically or medically vulnerable

• Covers: Direct and indirect medical education expenses

• Sites: FQHCs & FQHC Look-Alikes, community mental health centers, rural health clinics, IHS or Tribal clinics, and Title X clinics (family planning clinics)

TEACHING HEALTH CENTER (THC) FUNDING

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ACA = Affordable Care Act, FQHC = federally qualified health centers, IHS = Indian Health Service

Detail on Medicare payments

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Hospital-specific, base-period per resident amount (PRA) to cover direct costs incurred by teaching hospitals:• Salaries and fringe benefits of residents• Salaries and fringe benefits of supervising

faculty• Institutional overhead costs (e.g., programs’

budgets, program director/administrator time)• GME Office staff

MEDICARE DME (DGME) FUNDING

DME/DGME = Direct (Graduate) Medical Education

An additional payment based on the “IME adjustment factor”• Additional costs associated with the teaching of

residents (e.g., clinical inefficiencies)• Severity of illness (patients require specialized

services and treatment programs)• Formula based on the resident-to-bed ratio

(different formula for rehab & psych units)

MEDICARE IME FUNDING

c x [(1 + r).405 - 1]

IME = Indirect Medical Education

Approved programs• ACGME, AOA, CODA, CPME and ABMS• Others that lead to board certificationLocation• Hospital-based • Non-hospital-based if hospital pays 100% of the costsResidency level & type• Initial Residency Period (IRP) = 1.0 FTE DME & IME• After IRP = 0.5 FTE DME/1.0 FTE IME • Gero, child neuro & prev med = 1.0 FTE for IRP + 2 yrs

“ALLOWABLE” GME EXPENSES

ACGME: Accreditation Council for Graduate Medical Education, AOA: American Osteopathic Association), CODA: Commission on Dental Accreditation, CPME: Council on Podiatric Medical Education

“ALLOWABLE” GME EXPENSES

Activity type• Patient care• Didactics • Non-patient specific research (DME only)• Patient specific research (difficult to track)

Resident cap• 1997 Balanced Budget Act• Dental and podiatry programs exempt• Adjustments allowed (e.g., affiliated groups, closed

hospitals, redistribution)

UW Medicine GME funding

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Hospital FY14 FTEs DGME Cap DGME IME Cap IME

UWMC 381 255 $7,667,429 240 $25,166,612

HMC 307 172 $5,927,039 152 $16,097,710

UW MEDICINE MEDICARE FUNDING

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Total DGME per actual resident FTE:UWMC DME = $20K

HMC DME = $19K

Total IME per actual resident FTE:UWMC DME = $66KHMC DME = $52K

Average cost to train a resident=

$152,000+ per year

21Source: AAMC’s What Does Medicare Have to Do With Graduate Medical Education?

UWMC$27,414,814

Harborview$21,639,098

Children’s$15,709,108

VA$10,351,916

Other$6,755,925

UW GME FUNDING (FY14)

UWMC402

Harborvie329

Children's218

VA165

Other241

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Funded Positions by Site

Direct Costs (stipends/benefits/admin) by Site

Questions?

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