Meritus Health Family Medicine Residency Program

September 10, 2015

Presentation to IGME Workgroup

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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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Meritus Health Service Area

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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

6West Virginia School of Osteopathic Medicine

Meritus Medical Center

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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