MERC: medical education & research costs Minnesota’s Clinical training support Program
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Transcript of MERC: medical education & research costs Minnesota’s Clinical training support Program
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MERC:MEDICAL EDUCATION & RESEARCH COSTS
MINNESOTA’S CLINICAL TRAINING SUPPORT PROGRAM
Mark Schoenbaum
Minnesota Department of Health
September 22, 2014
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Original MERC Principles• Medical education benefits society at large, not just direct
health care stakeholders.• The cost of medical education should not be borne by
only a few hospitals or medical centers, but fairly allocated across the health care system.
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1995 MERC Task Force
• Teaching institutions should be responsive to evolving workforce needs related to specialty, profession and skill mix;
• Health workforce should support cost, access and quality goals;
• Public policy incentives should be developed to promote training of generalists, resolve maldistributions, and influence gender/diversity mix.
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MERC Formula Timeline
• MERC 1998-2003: 100% Cost per FTE
• PMAP 2001-2003: 50% Cost per FTE 50% MA volume
• 2004-2007: 67% cost per FTE, 33% MA volume10% discretionary fund
• 2007-2013: 100% MA volume20% bonus for high volume
• 2014 - on: 100% MA volume10% bonus, ends in 2016
• Roughly $600M distributed since 1998
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MERC Sources and Uses
MERC Formula:MA Manged Care Carve-out 49,552 57,127 MERC formulaCigarette tax 3,937 150 MDH AdminMatch on cigarette tax 3,788Subtotal 57,277 57,277
HCAF 1,000 1,000 Great MN Family Med Residencies
Transfers:U of M Transfers 19,557 19,557 Returned to U of MMatch on U of M Transfers 10,857 1,035 HCMC clinical medical education
1,122 Dental Innovations grants8,700 Transfer to General Fund
Subtotal 30,414 30,414
Grand Total 88,691 88,691
Sources Uses
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MERC Funds outside the formula• Public program funds from DHS:
• $2,157,000 to the University of Minnesota Board of Regents for the purposes in sections 137.38 to 137.40;
• $1,035,360 to Hennepin County Medical Center for clinical medical education;
• $17,400,000 to University of Minnesota for purposes of medical education;
• $1,121,640 to clinical education dental innovation grants
• Health Care Access Fund:• $1,000,000 to family medicine residency programs outside
the 7-county metro area focused on training of family medicine physicians to serve non-metro communities.
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MERC Formula Funds – 2014 base
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MERC Formula 2014 - present
• Training site must be a Medicaid provider• Funds divided based on relative Medicaid volume among
all applicants
• Outlier limiters:
• Site must have at least .1 trainee FTE
• No sites shall receive a grant per FTE trainee that is in excess of
the 95th percentile grant per FTE across all sites
• No site can receive more than its reported expenditures
• Bonus to largest sites phased out
• 20% through FY 13, 10% in FY 14 & 15, 0% thereafter
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MERC Eligibility
• Accredited clinical education programs for:
• Site must be funded in part by patient care revenues and be a Medicaid site
Physicians Pharmacists
Dentists Chiropractors
Advanced Practice RNs Physician Assistants
Psychologists Dental therapists and advanced dental therapists
Clinical social workers Community paramedics
Community health workers
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Use of MERC Funds
• Funds flow from MDH –> Sponsoring Institution –> Training Site
• Funds must be spent on clinical training
• Sites must report their expenses
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2014 MERC Distribution• 369 distinct sites received MERC funds• 83.9% of funding to hospitals• 10.9% to physician clinics• 2.5% to Pharmacies• 1.1% to Federally Qualified Health Centers• 0.1% to Dental Clinics• 71.1% of grant to Hennepin/Ramsey counties
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2014 MERC DistributionTop 20 Grant Recipients
Clinical Training Facility Location MHCP Provider Type FTEs Grant
HENNEPIN COUNTY MEDICAL CENTER MINNEAPOLIS HOSPITAL 403.0 $11,123,229
UMMC FAIRVIEW MINNEAPOLIS HOSPITAL 466.6 $4,811,309
REGIONS HOSPITAL ST PAUL HOSPITAL 176.0 $4,394,591
CHILDRENS HEALTH CARE MINNEAPOLIS MINNEAPOLIS HOSPITAL 46.2 $3,155,302
ABBOTT NORTHWESTERN HOSPITAL MINNEAPOLIS HOSPITAL 78.4 $2,208,541
NORTH MEMORIAL HEALTH CARE ROBBINSDALE HOSPITAL 40.0 $2,077,248
MAYO CLINIC HOSPITAL ROCHESTER ROCHESTER HOSPITAL 450.3 $2,001,856
ST CLOUD HOSPITAL ST CLOUD HOSPITAL 13.5 $1,999,411
CHILDRENS HOSPITALS & CLINICS OF MN ST PAUL HOSPITAL 51.4 $1,741,437
UNITED HOSPITAL INC ST PAUL HOSPITAL 16.4 $1,728,344
HEALTHEAST ST JOSEPHS HOSPITAL ST PAUL HOSPITAL 25.7 $1,114,428
HEALTHEAST ST JOHNS HOSPITAL MAPLEWOOD HOSPITAL 7.8 $993,652
GILLETTE CHILDRENS SPEC HOSP ST PAUL HOSPITAL 15.9 $961,707
ESSENTIA HLTH ST MARYS MEDICAL CNTR DULUTH HOSPITAL 28.9 $958,830
PARK NICOLLET METHODIST HOSP ST LOUIS PARK HOSPITAL 30.7 $891,551
MAYO CLINIC ROCHESTER PHYSICIAN 434.5 $798,072
MERCY HOSPITAL COON RAPIDS HOSPITAL 6.8 $666,858
PARK NICOLLET CLINICS ST LOUIS PARK PHYSICIAN 8.8 $542,276
FAIRVIEW SOUTHDALE HOSPITAL MINNEAPOLIS HOSPITAL 5.4 $540,271
MAYO CLINIC HOSPITAL ROCHESTER ROCHESTER HOSPITAL 172.8 $486,139
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2014 MERC DistributionGrant Ranges
Grant % Number of Sites FTEs$1,000,000 to $5,000,000 2% 11 1,767
$500,000 to $999,999 1% 8 539$100,000 to $499,999 5% 32 314
$50,000 to $99,999 6% 37 83$20,000 to $49,999 15% 96 290$10,000 to $19,999 12% 72 70
$5,000 to $9,999 13% 83 56$1,000 to $4,999 5% 30 3
Distinct Total 369* 3,221
The table below shows the number of sites and FTEs within specific grant ranges. Facilities receiving a grant less than $5,000 qualified only for cigarette tax funds.
* 252 additional applicants qualified for a grant under $1,000 and received no funds