A Collaboration to Increase Family Medicine GME Medical College of - - PowerPoint PPT Presentation

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A Collaboration to Increase Family Medicine GME Medical College of - - PowerPoint PPT Presentation

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A Collaboration to Increase Family Medicine GME Medical College of Georgia at Augusta University, Augusta University Health System and University Health Care System Joseph Hobbs, M.D., FAAFP Anna Ramanathan Professor and Chair, and the

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SLIDE 1

A Collaboration to Increase Family Medicine GME

Medical College of Georgia at Augusta University, Augusta University Health System and University Health Care System

Joseph Hobbs, M.D., FAAFP Professor and Chair, and the GAFP J.W. Tollison, M.D., Distinguished University Chair Department of Family Medicine Senior Associate Dean for Faculty Affairs Medical College of Georgia

2/23/17 – ADFM Presentation

Anna Ramanathan Department Administrator Department of Family Medicine Medical College of Georgia

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SLIDE 2

Augusta University Health System

Strategic Investment in Primary Care Growth

  • Increase primary care access for projected covered lives
  • Market primary care services to enterprise employees
  • PCMH transformation of primary care resident faculty practice

sites based on FM model

  • Expand AUHealth System’s primary care remote site(s)
  • Develop primary care community partnerships
  • Increase UME and GME learning sites
  • Increase FM GME and faculty CFTE
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SLIDE 3

Augusta University

  • Comprehensive research institution
  • ~9,000 students
  • 1,000 full time faculty
  • 7,000 staff
  • 125 educational programs
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SLIDE 4

Augusta University

Summerville Campus

(5 Colleges)*

Medical College

  • f Georgia

21 Centers and Institutes 6 Basic Science Departments 16 Other Clinical Departments AUHealth System AU Medical Associates FM Center and FM Inpatient Service Department of Family Medicine

* Health Science Campus: Medical College of Georgia, College of Allied Health Sciences, Dental College of Georgia, College of Nursing ** Summerville Campus: Hull College of Business, College of Education, The Graduate School, College of Science and Mathematics, Pamplin College of Arts, Humanities, and Social Sciences

Health Science Campus

(4 Colleges)**

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SLIDE 5

Medical College of Georgia

  • Faculty size

– 615 full time faculty – 217 part time faculty – 2,081 volunteer faculty

  • Medical school enrollment (230 students)

– Main campus (190 students per class)

  • 3 Clinical Campus

– Augusta University/University of Georgia Medical Partnership 4 year campus (40 students per class) – 534 residents/fellows and 45 programs

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SLIDE 6

Augusta University Health System

  • 154-bed children’s and 478-bed adult hospitals
  • Level I adult and pediatric trauma center
  • Ambulatory care services

– Practice sites for 80 specialties, including Family Medicine Center – Digestive Health Center – Georgia Radiation Therapy Center – Sports Medicine Center – Georgia Cancer Center – Remote primary care and specialty practice sites

  • Georgia War Veterans Nursing Home
  • Roosevelt Warm Springs Rehabilitation and Specialty Hospitals
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SLIDE 7

1 24 total ACGME position 2 6 ACGME rural track positions

FM Clerkship UME Community Faculty Network FM Interest Group FM General Student Advising FM Required and Elective Preclinical and Clinical Courses Rural Tract FM Residency Program2

Osteopathic Program Component

GME Hospital Affiliates GME Community Faculty Network Executive Council Department Administrator Health Disparities Unit Training and Research Grant Management Practice-Based Research Network, HamesNet IPPH Coordination AUMA Practice Site Liaison Family Medicine Resident/Faculty Practice Site Electronic Health Record Maintenance Outpatient Clinical Programs Chair Undergraduate Medical Education Program Graduate Medical Education Program Research and Discovery Programs Inpatient Clinical Programs AU Medical Center CQI Liaison FMIS Rural Health Education and Service Initiatives AUMA CQI Liaison Geriatric Programs GWVNH MCG FM Residency Program1

MCG Department of Family Medicine

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SLIDE 8

MCG Family Medicine Residency Program

Funding

  • Funding Support

– AUHealth System via DME and IME – State FM capitation through Georgia Board for Physician Workforce – AU Medical Associates – Training grants – Faculty and resident clinical coverage contracts (e.g., Georgia War Veterans Nursing Home) and FM departmental reserves

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SLIDE 9

Current Family Medicine GME Positions and Faculty CFTE

  • Faculty FTE 18.65
  • Faculty CFTE 8.49
  • 42 approved GME positions
  • 30 funded GME positions
  • MCG (24)
  • Rural 1+2 (6)
  • 11 Community Clinical Faculty
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SLIDE 10

MCG Department of Family Medicine

  • Personnel

– 37 Faculty

  • 19 MD/DO on campus clinician educators
  • 5 PA on campus joint appointment clinician educators
  • 1 EdD nurse administration
  • 2 PhD scientists
  • 3 MD regional campus
  • Dean’s staff

– 1 PhD on campus psychologist – 2 MD regional campus – 1 PhD – 2 MSW/MPA

– 22 academic staff – 32 clinic staff – 241 community clinical faculty – 30 residents

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SLIDE 11

MCG Department of Family Medicine

  • Family Medicine Center

– 15,000 sq ft – Largest single site of primary care in region – NCQA recognized Level 3 PCMH – ~37,000 patient visits per year – Family Medicine EHR in enterprise EHR environment

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SLIDE 12

MCG Department of Family Medicine

Service and GME Growth Initiative Goals

  • Increase on campus and

community primary care access

  • Increase primary care GME in

response to increased Georgia UME

  • Increase GME and UME access to

campus and community clinical sites

Challenges

  • Financial and space constraints

for additional residents and faculty

  • Most clinical rotations occurring in

AUHealth System

  • Recruitment competitiveness of

large community health systems

  • Insufficient exposure to

community based contemporary FM models

  • Disproportionate resident

exposure to complex primary care

  • Historic service and teaching

relationships with community health system

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SLIDE 13

MCG Department of Family Medicine

Service and GME Growth Initiative

  • Opportunities

– 36 ACGME approved positions

  • 24 AUHealth System funded positions
  • 12 approved positions obtained in response to CMS national redistribution of unused

positions

– AUHealth System clinical growth initiative

  • Planned hospital in adjacent county
  • Expansion of primary care services
  • Functional integration and “right-sizing” of faculty practices
  • Changing healthcare environment

– Educationally willing external partners

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SLIDE 14

MCG Department of Family Medicine

Service and GME Growth Initiative

  • Opportunities

– Governor’s statewide GME growth initiative

  • Board of Regents “GME Regents Evaluation and Assessment Team” (GREAT)

– Increase primary care GME positions – Increase GME positions in identified specialty deficits (e.g., psychiatry, general surgery, etc.) – Target 400 new GME positions in GME naïve hospitals – Incentivize GME position development and startup

– Georgia Board for Physician Workforce

  • State capitation for community hospital based primary care GME
  • Federal match component
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SLIDE 15

Strategic Initiative

Increase Family Medicine GME and Faculty CFTE Current

  • Faculty FTE 18.65
  • Faculty CFTE 8.49
  • 42 approved GME positions
  • 30 funded GME positions
  • MCG (24)
  • Rural 1+2 (6)
  • 11 Community Clinical Faculty

Initial Proposal

  • 24.65 Faculty FTE
  • 13.5 faculty CFTE
  • 42 approved GME positions
  • 42 funded GME positions
  • MCG (36)
  • Rural 1+2 (6)
  • 18 Community Clinical Faculty
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SLIDE 16

Statewide Strategy

Expanding GME in GME Naïve Hospitals

  • Governor’s initiative committing $20 million over 5 years for start up

support

  • Funding to establish 400 residency positions at new teaching

hospitals to reach SE region resident per capita rate

– Hospitals required to match incentives dollar for dollar – New program focus predominantly on primary care and specialties with significant deficits in GA (e.g., general surgery) – Existing GME program expansion purposely excluded

  • Smaller return on investment
  • Existing position cap and smaller per resident DME/IME amount
  • GME expansion managed by GREAT
  • Advisory committee to GREAT
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SLIDE 17

University Health Care System

A Potential Collaborating Partner

  • 580 bed hospital
  • Heart & Vascular Institute
  • W.G. Watson, M.D. Women’s Center
  • Geographic decentralized primary care and specialty

services

  • Recent area hospital health system acquisition
  • Emergency department with designated Chest Pain and

Primary Stroke centers

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SLIDE 18

Reasons for Collaboration

MCG Family Medicine

  • Increase FM GME using MCG ACGME approved positions and

University Health Care System’s unused DME and IME

  • Increase training capacity to match FM ACGME approved positions
  • Increase service capacity at AUHealth System
  • Provides GME training experiences outside the AHC in community

settings

  • Enhanced FM recruitment potential based on AHC and community

health system educational interface

  • Access to extramural capital beyond DME and IME required to

support FM GME

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SLIDE 19

Reasons for Collaboration

University Health Care System

  • Protects current IME and DME positions
  • Provides support of statewide GME initiative
  • Exposes 36 MCG FM residents to health system
  • Creates physician recruitment opportunities
  • Increasing provider satisfaction to those interested in teaching
  • Marketing AHC affiliation
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SLIDE 20

GME Collaboration Challenges for University Health Care System Past discontinuation

  • f affiliation

with many MCG GME programs Loss of unused DME and IME positions in most recent CMS GME positon redistribution GREAT’s knowledge of GME position loss because of non-utilization Office and hospital primary care constraints Resident position cap established more than 2 decades ago

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SLIDE 21

Partner Benefits for MCG AUHealth Additional state capitation through Georgia Board for Physician Workforce Market advantage for resident recruitment and recruitment competiveness Maintenance of resident continuity activity at MCG, AUHealth in PCMH environment Decreased requirement to engage distant health systems to meet resident training requirements Additional FM regular and clinical faculty and practice sites, and FMC space expansion Increased community based subspecialty experiences

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SLIDE 22

Factors Facilitating GME Collaboration University Health Care System commitment to support MCG FM and

  • ther GME expansion

with IME, DME, and

  • ther financial assets

Future collaborative service

  • pportunities

Exception to the GME naïve hospital rule for state incentives of GME expansion University Health Care System academic branding Increased GBPW capitation for new FM GME positions FM resident exposure to University Health Care System’s services and employment

  • pportunities

Additional UME access to University Health Care System services

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SLIDE 23

MCG and Augusta University Health System

GME Collaboration with University Health Care System

  • University Health Care System applied/received incentive funds from

GREAT to support 12 MCG FM GME positions

  • University Health Care System to provide direct resident cost if current

DME and IME funding inadequate to do so

  • Establish a more realistic financial tolerance to support 6 positions
  • Using existing hospital base and University Health Care System owned

primary care assets to support off campus resident education

  • Willingness to accept credit for rotations in hospital based services such

as emergency department and hospitalist services to satisfy resident FTE assignment

  • Avoidance of dollar for dollar match requirement of GREAT funds of

~$800,000

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SLIDE 24

Strategic Initiative

Increase Family Medicine GME and Faculty CFTE Current

  • Faculty FTE 18.65
  • Faculty CFTE 8.49
  • 42 approved GME positions
  • 30 funded GME positions
  • MCG (24)
  • Rural 1+2 (6)
  • 11 Community Clinical Faculty

Final Proposal

  • 24.65 Faculty FTE
  • 11.5 faculty CFTE
  • 42 approved GME positions
  • 36 funded GME positions
  • MCG (30)
  • Rural 1+2 (6)
  • 18 Community Clinical Faculty
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SLIDE 25

Where Are We Now?

  • Marketing new affiliation
  • Active recruitment for 2 additional residents funded by University Health

Care System

  • Clinical rotation development using University Health Care System’s

clinical sites and physicians

  • Exploring expansion after gaining experience with 6 initial residents
  • Teaching development for University Health Care System faculty
  • Seeking support for the remaining 6 unfunded positions from both

University Health Care System and AUHealth System

  • Active recruitment for additional faculty complement in support of

residency expansion

  • Securing state capitation funding
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SLIDE 26

Joseph Hobbs, M.D., FAAFP Professor and Chair, and the GAFP J.W. Tollison, M.D., Distinguished University Chair Department of Family Medicine Senior Associate Dean for Faculty Affairs Medical College of Georgia Anna Ramanathan Department Administrator Department of Family Medicine Medical College of Georgia