1. Meritus Health Family Medicine Residency Program September 10, 2015 Presentation to IGME Workgroup

2. 1 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

3. 2 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

4. 3 Meritus Health Service Area

5. 4 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

6. 5 West Virginia School of Osteopathic Medicine Meritus Medical Center

7. 6 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

8. 7 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

9. 8 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

10. 9 HSCRC Evaluation Process New Program or Expansion Need EvaluationFunding 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)

11. 10 Partial Application for Residency Programs Template I.Amount of GME Request a)Direct Medical Education b)Indirect Medical Education Show calculations / support in appendix II.Overview of Program a)Type (Primary Care; Specialty) b)Number of Residents c)School Affiliation d)Timing III.Demonstration of Need for Program IV.Support for Program a)Address Three Part Aim b)Address Population Health