Mission Support Analysis September 2018 Patrice Patrick - - PowerPoint PPT Presentation

Mission Support Analysis

September 2018

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Patrice “Patrick” Delafontaine, MD Hugh E. and Sarah D. Stephenson Dean, MU School of Medicine Professor of Medicine and Medical Pharmacology & Physiology

Funds Flow Presentation Agenda

• Key Questions – Mission Support for Research & Teaching

– What are the mechanics of funds flow distribution from MUHC to the School? – How does the School of Medicine allocate funds to support research & teaching? – How Does the allocation align with strategic needs of the School & mission of the University?

• Funds Flow Model Definition

– Common AMC Funding Model – Role of School, Faculty Practice Plan and Medical Center in Funds Flow – MU Funding Model

• SoM/MUHC Sources & Uses of Funds for Teaching, Research & Clinical

Services

– Clinical – University Physicians Generated Funds – Administrative - – Academic Achievement Support – Teaching – Medical Students, Residents & Fellows – Strategic funding

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Funds Flow Model

All three missions of a medical school—research, education, and patient care— are interdependent, and each supports the others. Each school has its own unique mix of revenue sources and expense sharing among the medical school, faculty practice plan(s), parent university, and affiliated hospital(s). Despite these differences, revenues from clinical care subsidize research and education missions at every medical school. Clinical revenue for the SoM and MUHC is generated primarily by the faculty of the School of Medicine. A portion of the clinical revenue they generate for the hospital is sent back to support the mission of the school via the funds flow model.

Academic Medicine 2012 Dec; 87(12):1746-51. doi: 10.1097/ACM.0b013e3182713b77. Perspective: follow the money: the implications of medical schools' funds flow models. Miller JC1, Andersson GE, Cohen M, Cohen SM, Gibson S, Hindery MA, Hooven M, Krakower J, Browdy DH

An Overview of Medical School Funds Flow:

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Mission Support Definitions

CARTS as a Funds Flow Methodology:

• “C” - Clinical programmatic support & new clinical program investment
• “A” - Cost Report Medical Directorships and time commitments
• “R” - Academic Achievement Funds to support research & academics
• “T” - Teaching assignments and time commitments
• “S” - Strategic support: mission-critical clinical programs that cannot
• therwise support themselves, recruitment ramp up

The School of Medicine implements this methodology via:  CARTS allocation process from MUHC for clinical & administrative funding  Academic Achievement Support from MUHC Agreement for research funding  Mission Based Mgmt. Funding Model distributes funds for teaching  Grants Management with OSPA for Sponsored Research

MU Adopted the CARTS Model for Funds Flow in 2004

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MU Funds Flow Model FY19

University of Missouri MU Health Care SoM University Physicians Funded Research Sponsors GRA

Mission Support

Dean & Clinical Grant Expend.

School of Medicine Distributes Academic & Clinical Support Funds Clinical Admin. Research Teaching Strategic Inst. Support OH Alloc. F&A Main School of Medicine Revenue Sources Clinical Departments Basic & Clinical Science Departments The comprehensive funds flow model for the School of Medicine consists of multiple sources including MUHC but research sponsors and the University are key sources of mission support

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Total Funds Received from MUHC for Mission Support Mission Support funds the School receives from MUHC are allocated by MUHC and SoM leadership. Academic Achievement funding is reserved for research and teaching and are allocated based on NIH funding potential, research infrastructure, scholarly pursuit needs and related research and academic mission support needs.

Total MUHC Support Clinical Mission Administrative Services Recruitment Teaching Mission Strategic Initiative Academic Achievement

FY 16 62,520,627 27,508,976 6,488,472 2,655,612 8,072,352 2,545,215 15,250,000 FY 17 65,151,780 29,654,902 7,222,547 550,004 8,287,102 2,377,225 17,060,000 FY18 64,432,398 28,363,020 6,380,219 308,460 8,580,152 2,800,547 18,000,000 FY19* 65,000,000 31,129,383 7,797,681 500,000 9,109,051 1,463,885 15,000,000 Total $ 257,104,805 $ 116,656,281 $ 27,888,919 $ 4,014,076 $ 34,048,657 $ 9,186,872 $ 65,310,000

Note * FY19 Recruitment & Academic Achievement funds are estimated amounts based on current budget projections

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Allocation of funds to support Research and Teaching pursuits for the School of Medicine

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FY2018 School of Medicine Faculty FTE

SoM Faculty divide their time into 3 major categories – Research, Teaching & Clinical Similar to all medical Schools, MU has a larger number of clinical faculty than research faculty – this is due to market and funding requirements of the SoM and their AMC Faculty Count is Grouped by Main Mission

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FY17 Public Medical Schools Revenue By Source

Fully-Accredited Public Medical School Revenue by Source, 139 Medical

• Schools. Source: LCME Part 1-A Annual Financials

Current “Typical” AAMC Member SoM Revenue Sources

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MU SoM FY18 Revenue Sources: $385M

Academic Support 4% CARTS 12% Clinical 59% Gifts 2% GRA 12% Research & Grants 11%

Academic Support 18,777,929 5% CARTS 43,958,313 11% Clinical 228,918,965 59% Gifts 7,291,676 2% GRA 46,023,127 12% Research & Grants 40,751,064 11% Total 385,718,072

MU SoM Revenue Sources are more reliant on directly generated clinical funds to cover teaching, research and clinical pursuits than its peers

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FY18 Actual Expenditures: $376M

Administrative 7% Strategic 4% Clinical 63% Resident - Teaching 3% Teaching 8% Research 14%

Administrative 25,213,849 7% Strategic 20,569,312 5% Clinical 235,620,958 63% Resident - Teaching 10,104,938 3% Teaching 32,076,314 9% Research 52,048,238 14% Total $ 375,633,609

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5 Year Clinical Revenue From Patient Care

(in Thousands) University Physicians Summary

FY2014 FY2015 FY2016 FY2017 FY2018

Sources:

Net Professional Fee Charges $440,375 $468,908 $513,286 $550,477 $558,085 Net Professional Fee Collections $162,773 $173,849 $191,265 $204,871 $206,288 Uses: Net UP Direct Operating Expenses per 440.040 17,008 18,333 21,443 23,606 24,006 Net Teaching, Research & Clinical Faculty Support 32,545 37,452 35,693 35,004 30,583 Net Deans Office Account Funds 9,390 10,043 11,095 11,634 11,600 Professional Liability 7,666 7,504 7,105 7,722 5,144

440.040 B: Faculty members of the School of Medicine of the University of Missouri may be engaged in one or more of the following employment duties: teaching, research and patient care. Patient care is an integral part of the educational mission of the school for it provides to the instructor and the medical student the clinical experience essential to medical education. SoM University Physicians Practice Plan Clinical Revenue is a separate component of funds flow and is governed by CRR 440.040

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Clinical Support (CARTS “C”)

452000 - CARTS C FY16 $25,908,976 FY17 28,054,902 FY18 26,443,020 FY19 29,209,383

• CLINICAL MISSION: 4yr approx: $116.6M

Support for clinical departments’ services to address clinical missions of SoM and MUHC.

• Salary support (but not incentive) is applied to faculty, advance practice providers and

to ancillary support for clinical operations

• Funding determinations are based on departmental requests for both specific services

and programs, and support for projected budget deficits due to clinical market compensation costs not sustainable through patient collections only.

• Clinical departments that routinely receive support include:
• Anesthesiology,
• Child Health, Dermatology,
• Family and Community Medicine,
• Internal Medicine,
• Ophthalmology,
• Pathology,
• Surgical services for pediatrics

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Administrative Support (CARTS “A”)

452000 – Administrative Services FY16 6,488,472 FY17 7,222,547 FY18 6,380,219 FY19 7,797,681

• Compensation for clinicians identified as a Medical Director at University

Hospital, Women’s & Children, Bio-Joint and MOI is based on base salary

• nly. Level of support to be provided and accountability are determined

by the Chief Medical Officer and approved by the Dean and CEO. A Directorship Memorandum is signed by each director acknowledging their expectations.

• Support for MUHC related administrative responsibilities for clinical

department chairs for oversight and coordination of the clinical mission. ADMINSTRATIVE SERVICES:

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Academic Achievement Allocations

FY14 FY15 FY16 FY17 FY18 Academic Achievement Allocation Categories $ 4,740,000 $ 15,110,000 $ 15,250,000 $ 17,060,000 $ 18,034,694

Chair/Faculty Research & Academic Development

850,894 961,054 1,805,081 4,231,593 5,659,309

Research Renovations/Construction

266,424 497,140 424,013 149,516 1,643,742

Research Equipment Purchases

217,922 68,474 370,680 198,097 1,524,769

Clinical Mission Reinvestment

1,010,581 885,077 1,283,035 2,036,809 1,716,332

Academic General Mission Support

862,972 833,948 1,027,070 1,152,937 1,060,989

Research General Mission Support

697,606 40,500 417,695 430,658 414,083

MD/PhD Program Model Funding

183,324

Orthopaedics Research Funding

106,888 122,370 136,220 163,110 109,350

Student Scholarships

1,938 33,564 35,697 56,301 295,609

Transfers to academic endowment corpus

200,000 430,049 200,000 562,500

Ending Balance - Dean's Office

6,466,560 18,378,955 22,461,336 27,524,913 33,835,980

Note: MD PhD program support in prior years has come from other funds available

This part of mission support is allocated for research & academic development program growth Allocations are based on NIH funding potential, research infrastructure, scholarly pursuit needs and related research and academic mission support needs

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Academic Support Projected

FY19 FY20 FY21

Academic Achievement Projected Support

$ 15,000,000 $ 12,000,000 $ 12,000,000

Chair Program Hire & Faculty Development 10,660,454 12,784,409 13,505,000 Research Recruitment 1,344,938 824,062 824,062 Research Renovations/Construction 10,280,000 5,100,000 Research Equipment Purchases 250,000 250,000 250,000 Clinical Mission Reinvestment 1,000,000 1,000,000 1,000,000 Academic General Mission Support 100,000 100,000 100,000 MD/PhD Program Model Funding 200,000 250,000 300,000 Scholarships 300,000 300,000 300,000 Ending Balance 20,120,750 12,512,279 9,233,217 Note: Support Projection is based on rolling historic average without material clinical growth

Future Year’s projection reflects Chair & other research faculty recruitments along with holding clinical performance and MUHC growth steady

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Newly recruited faculty and grant transfers Research Intensive Faculty Recruitment

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Research & Grant Results

By focusing research support and funding on more specific areas, our award rate increases

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Research Expenditures NIH Research Expenditures

$26,576,839 $27,486,440 $29,956,393 $31,067,568

$10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $35,000,000

FY15 FY16 FY17 FY18

Total Research Expenditures SOM

$16,784,755 $17,015,500 $18,578,823 $19,721,702

$10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $35,000,000

FY15 FY16 FY17 FY18

NIH Research Expenditures SOM

Research Expenditures

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NIH Awards & SOM Ranking

$17,081,401 $18,727,920 $18,651,395 $22,036,338 $24,232,592

94 91 89 88 86 $- $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $35,000,000 85 90 95 100 105 110 FY13 FY14 FY15 FY16 FY17

NIH Awards SOM Ranking

SOM NIH Ranking

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Teaching Support (CARTS “T”)

452000 – Teaching FY16 8,072,352 FY17 8,287,102 FY18 8,580,152 FY19 9,109,051

TEACHING MISSION: 4yrs approx. $34M

Accredited residency and fellowship program funding is based on the Accreditation Council for Graduate Medical Education (ACGME) guidelines.

Number of ACGME Residents and Fellows

FY16 FY17 FY18 FY19

# of Residents (both ACGME and non-ACGME)

351 370 390 401

# of Fellows (both ACGME and non-ACGME)

80 80 86 89

No residency or fellowship programs are currently on warning or probation by the ACGME.

Selected Highlights

• ENT residents scored in the top 10 percentile in their board certification exams.
• In FY17, Residents in training had 324 abstracts accepted for presentation at national

conferences, 110 publications and were co-authors on 26 book chapters. 88% of residents had abstracts accepted for presentations. (See table below.)

• Growth in number of residency and clinical fellowship training programs and number of

residents/fellows.

• Upward trajectory of resident and faculty evaluations of the radiology residency training

program, now meeting or exceeding national averages in all categories.

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5 Year GRA Allocation Funding

GRA is used to fund the teaching and research missions of the School of Medicine

$32.1 $32.0 $31.5 $29.8 $27.4 $25.9 $9.7 $9.7 $9.7 $5.7 $4.9 $5.8 $4.0 $4.9 396 453 360 370 380 390 400 410 420 430 440 450 460 $- $5.0 $10.0 $15.0 $20.0 $25.0 $30.0 $35.0 $40.0 $45.0 2014 2015 2016 2017 2018 2019 Medical Students Allocation (Millions) GRA Allocation Expansion Allocation Expansion Withholds Medical Students

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CARTS – S - Strategic

393000 – Strategic Recruitment FY16 $2,655,612 FY17 550,004 FY18 308,460 FY19 500,000

RECRUITMENT & STRATEGIC SUPPORT: 4yrs approx. $13.1M

393000 – Strategic Initiatives 500,000

• 0-
• 0-
• 0-

452000 – Strategic Initiatives 2,045,215 2,377,225 2,800,547 1,463,885

• Recruitment - Coverage for clinical deficit in the initial year of new clinical provider faculty hired

in a strategic initiative area.

• Funding is provided for clinical initiatives identified for growth and development by both the

Dean of the School of Medicine and the CEO of Missouri University Hospital. There are four areas of current strategic priority for strategic support: Primary Care, Cardiovascular, Oncology and Neuroscience. Other services that collaborate with these clinical areas also receive some level of support. Primary care sites and providers are the “front door” to a health system. Having adequate access for patients to these sites and services is a critical quality factor for the SOM and MUHC.

• Primary Care Expansion
• 12 primary care positions hired in FY17 and FY18, 6 each year. We are targeting new primary care

positions to cover an additional 20,000 lives, for hire in FY18 - FY21. New practice locations include Southwest Columbia, South/Discovery Ridge, Northeast Columbia, Keene Street

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Challenges

• Research wet & dry lab facilities generate a good return at $320

per square foot but our current space of 97,000~ square feet is 97% allocated. Additional space and infrastructure is needed.

• The CARTS Mission Support funds are dependent on current and

future performance of the clinical faculty & MUHC facilities relative to payor reimbursement changes as well as growth of clinical scale.

• The “Mechanics” of allocation needs to avoid being transactional in

nature in order to maintain appropriate regulatory separation and to align the SoM and its Practice Plan with the AMC.

• State Appropriations allocations are an important source of funding

for research pursuits and should not be replaced with clinical funds.

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Conclusion

Questions?

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