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MERC: medical education & research costs Minnesota’s Clinical training support Program. Mark Schoenbaum Minnesota Department of Health September 22, 2014. Original MERC Principles. Medical education benefits society at large, not just direct health care stakeholders. - PowerPoint PPT Presentation
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MERC:MEDICAL EDUCATION & RESEARCH COSTS
MINNESOTA’S CLINICAL TRAINING SUPPORT PROGRAM
Mark Schoenbaum
Minnesota Department of Health
September 22, 2014
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.
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.
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
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
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.
MERC Formula Funds – 2014 base
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
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
Use of MERC Funds
• Funds flow from MDH –> Sponsoring Institution –> Training Site
• Funds must be spent on clinical training
• Sites must report their expenses
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
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
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