Post on 01-Jan-2016
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Introduction
Meritus believes that establishing a Primary Care Residency Program in Rural Maryland will assist the State in achieving the goals of the IGME Workgroup.
• Focused on Triple Aim
• Curricula addresses Population Health
• Funded in Equitable and Efficient Manner
• Augments what is Good about Residency Training Today
If Primary Care Residency Programs were established, two key challenges should be addressed:
• Evaluating the need of the Program
• Determining the appropriate funding
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Meritus Health
Meritus Medical Center opened in December 2010 to replace the former Washington County Hospital in Hagerstown, MD
– 243 licensed beds for acute and rehabilitation care – 41 nursery bassinets– Single patient rooms
Services offered include:– Special care nursery– Level III trauma program designated as an EMS base station by the state– Certified primary stroke center– Wound center re-accredited with distinction in hyperbaric medicine– Award-winning cardiac catheterization laboratory
Outpatient needs are met through:– John R. Marsh Cancer Center– Center for Breast Health– Total Rehab Care– 19 primary and specialty care practices that make up Meritus Medical Group
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Osteopathic Family Medicine Residency
• Approval for an 18 resident program was received in June 2015 from the American Osteopathic Academy
• Leadership for the new program includes Tom Gilbert, DO, Director of Medical Education
• Widespread support from the medical staff
• Core faculty include 6 primary care physicians, 1 hospitalist, and 1 pharmacist
• Partnering with West Virginia School of Osteopathic Medicine and Mountain States OPTI
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HSCRC Existing Funding Mechanisms
General Funding• Full Rate Application
– Review of total regulated costs of hospital– Objective calculation based on approved methodology and efficiency standard– Subjective analysis supporting hospital request above calculation– Time consuming (~6 months from preparation to final approval), technical and
costly
• Partial Rate Application– Review of one specific aspect of hospital’s cost structure– Flexibility and variation in the structure and evaluation of the request
Residency Funding• Included as part of a Full Rate Application for incremental funding• DME/IME credit in efficiency standard
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Recommended Residency Funding Mechanism
Partial Rate Application that meets Identified Criteria
• Cost of Program– Comparison to Statewide Averages– Comparison to National / Regional Averages
• How the Program meets the Triple Aim, for example:– Training that is primarily in the ambulatory setting focused on the patients in
the community we serve– Training that emphasizes high quality and safe care with a curriculum that
emphasizes reduction in harm measures such as the Maryland Hospital Acquired Conditions
– Training that emphasizes cost conscious care such as reducing unnecessary utilization of resources and reductions in readmissions
– Training that emphasizes team-based care and helps residents become effective team members and leaders
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Recommended Residency Funding Mechanism (cont’d)
• How the Program improves Population Health, for example:– Increased access to primary care through a resident clinic focused on meeting
the needs of the chronically underserved / medically indigent patient– Starting a Family Medicine Residency will allow us to “grow our own” medical
staff and assist with recruitment– Training a community of physicians that can assist other rural hospitals with
meeting their unmet needs for access to primary care
• Demonstrate Need for the Program– Through Community Needs Assessment– Shortage of Primary Care Physicians– National Comparisons
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HSCRC Evaluation Process
New Program or Expansion Need Evaluation Funding Amount
• New teaching hospital or teaching hospital expanding program
• Demonstrated support of triple-aim: experience across the continuum of care
• Adequate access to particular sub-specialty within hospital’s service area- Medical staff demand- Physicians per capita- Characteristics of
population and community need
- Unemployment- Chronic disease
• Direct- Actual budgeted costs- Statewide average (by
Specialty)- Wage Adjusted Average• National • Regional
• Indirect- Current Regression
Model- Revised Regression for
IME- Resident / Bed
Approach (Medicare)
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Partial Application for Residency Programs Template
I. Amount of GME Requesta) Direct Medical Education
b) Indirect Medical Education
Show calculations / support in appendix
II. Overview of Programa) Type (Primary Care; Specialty)
b) Number of Residents
c) School Affiliation
d) Timing
III. Demonstration of Need for Program
IV. Support for Programa) Address Three Part Aim
b) Address Population Health