Teaching Health Center Graduate Medical Education Program: Two Year Update

American Association of Medical Colleges2013 9th Annual Physician Workforce

Research ConferenceSonghai Barclift, MD, FACOG

Branch ChiefBureau of Health Professions/Medicine and Dentistry

Health Resources and Services AdministrationDepartment of Health and Human Services

Objective

• Summary of the THCGME program• Major Growth Areas and Characteristics of

Current THCs• Highlight Innovations• Next Steps

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• THC model has a long history with several successful THCs dating back to the 1980s (Engebretsen 1989, Zweifler 1993)

• Increased likelihood of THC graduates choosing to practice in HCs/other underserved settings (Morris 2008, Reiselbach 2010)

• June 2010 MedPAC report

• Increase GME time spent in non-hospital settings

• Community-based care• Increase diversity

Sec. 5508 Affordable Care Act“Increasing Teaching Capacity”directed 230 million dollars over

5 years for the THCGME program

Components:• Section 338C(a), “National

Health Service Corps Teaching Capacity”

• Section 340H (Title III), “Payments to Qualified Teaching Health Centers”

Background THCGME Legislation

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Eligibility Criteria for THCGME

1• Community-based entity

2• Primary care residency

3• Institutional sponsor

4• New or expanded residency

5• Eligible residents

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What is a Community- Based Entity?

1. “Community-based ambulatory patient care center” that:

Operates a primary care residency program-FQHCs/FQHC Look-Alikes-Community mental health clinics-Rural health clinics-IHS or tribal health centers-Title X clinics

OR

Has collaborated to form an accredited GME consortium that operates a primary care residency program

1• Community-based entity

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Institutional Sponsor

3. Institutional sponsorshipMust be listed as institutional sponsor by relevant accrediting

body (e.g. ACGME, AOA, or CODA)Must be accredited or provisionally accredited at time of

applicationTeaching hospitals/academic institutions holding institutional

sponsorship are not eligible for THCGME funding

3• Institutional sponsor

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Traditional GME Model

Community Training Site

Teaching Hospital/ Academic Health

Center (inpatient)

Residency Program(continuity clinic)

Medicare GME $

Accreditation

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THC ModelCommunity

Training Sites

Hospital/ AHC

Medicare GME $

HRSA GME $Accreditation

Teaching HealthCenter

Residency

CHC

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THC Consortium Example

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THCGME Payment Model includes Accountability for Outcome Reporting

• THCs have to report on outcomes OR• Face possible 25% reduction in payment

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THCGME Growth

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FY 11

FY 12

FY 13

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%

ApprovedProvisional ApprovalExisting ExpansionIneligible

Teaching Health Center Application Success

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Approved THC sites

HRSA Teaching Health Centers

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Growth of THCs within FQHCs

• 74% of THCs have FQHC affiliation

• 32% of FQHC affiliated THCs are sponsored by Health Centers vs. 8% prior to funding

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Family MedicineInternal MedicineDentalPsychiatryPediatricsOB/GYNGeriatrics

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Types of Residency Programs

Source: HRSA THCGME application data

Difficult to Reach Populations

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71%

Mental/Psych

45%

Substance Abuse

37%

Homeless

Source: HRSA THCGME application data

Increasing Access

32%

School-Based Clinics

58%

Geriatrics

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Source: HRSA THCGME application data

Teaching Health Center Profile

45%

Team-Based Care

34%

PCMH

71%

MUA/HPSA

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Source: HRSA THCGME application data

Innovations

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Innovations in Training

Wright Center for GME-AT Still University of Health Science’s School of Osteopathic Medicine collaboration

•“…address national physician workforce shortage by empowering these communities to steward their workforce renewal”

•Six FQHCs29 FM positions

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• Innovations in Accreditation• 2-2-2 Family Medicine • “You must be the change you want to see in the world”-Ghandi

Mercy Medical Center Graduates currently working at SCHC

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• Spanish Immersion

• All 8 graduates of the first class will continue in a community based underserved setting

“…emphasizes the cultivation of future safety net healthcare leaders”

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Next Steps

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Non-CHC vs. CHC trained Residents Working in Underserved Settings

NHSCHPSA

MHC*

IHS*

RHC*M

UA*CHC*

0%5%

10%15%20%25%30%

Non-CHC CHC

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Morris et al., Fam Med 2008; 40(4)

Telling the complete THC story

George Washington University Evaluation/BHPR Performance Measures

•THCGME distinguished characteristics

•Cost of training in a community based settings

•Long-term Impact on the Workforce

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Contact Information

Songhai Barclift, MD., FACOGChief, Community Based Training BranchDivision of Medicine and DentistryHRSA/Bureau of Health Professionssbarclift@hrsa.gov

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