understanding the costs and benefits of outpatient teaching gimgel session faculty development...

Understanding the Costs and Benefits of Outpatient Teaching

GIMGEL Session

Faculty Development Project

James R. Boex, MBA

What Are We Going to Accomplish Today?

• understand the cost context of ambulatory training;

• learn how educational activities affect ambulatory sites’ operating costs;

• apply a cost model for ambulatory training to your own site;

• understand an approach to identifying the benefits of clinical training; and

• consider how this model for identifying benefits might apply to your own setting.

Understanding the Value Added to Clinical Care by Educational Activities*

HOW CAN WE MEASURE VALUE?

Any assessment of value must include both costs and benefits

in current jargon, “benefits” = “value added”

UNDERSTANDING COSTS IN CLINICALEDUCATION REQUIRES MANY AREAS

OF INVESTIGATION

cost measurement

trainee mix types of trainingactivities

quality oftraining how training affects

clinical productivity(activity analysis)

Understanding the Costs of Ambulatory Care Training*

Conceptual Costs Model

costs ATTRIBUTABLE to education

costs ALLOCATABLE to education

costs ASSOCIATEDwith education

direct costs

indirectcosts

educationinfrastructur

e

costs

*Academic Medicine, September 1998

Understanding the Costs of Ambulatory Training*

Definitions & Examples

• Direct Costs (strong relationship to cause): resident stipends, dedicated faculty time, etc.

• Indirect Costs (weaker relationship to cause): heat & light, space costs, estimated faculty time, etc

• Infrastructure Costs (weakest relationship to cause): more tests, assumed lower productivity, etc.

*Academic Medicine, September 1988

Measuring the Costs of Primary Care Education in the Ambulatory Setting*

The Cost of Education in Ambulatory Sites is

Approximately the Same as in Hospitals

$0

$200000

$400000

$600000

$800000

$1000000

$1200000

$1400000

$1600000

non-teaching site teaching site

infrastructure

direct & indirect

operating costs

24%12%

*Academic Medicine, May 2000

Assessing Ambulatory Primary Care Education - Costs, Methods and Quality:

Education Adds to CostsClinical Productivity Costs

ambulatory clinicians supervising principally PGY-2 and PGY-3 residents saw fewer patients than when not teaching

and half of the ambulatory clinicians reported that

teachingextended their 4-hr work sessions by an

average of 45 minutes per session

Measuring the Costs of Primary Care Education in

the Ambulatory Setting* Who Pays the Costs of Ambulatory Training?

0%

20%

40%

60%

80%

100%

sponsors sites teachers

doesn't paypays



More Centers Are Teaching Than Believed

0%

25%

50%

75%

100%

BCRR MGMA

non-teachteaching

If 33% - 50% of ambulatory care sites thought not to be teachingare in fact teaching, what are the implications of this for schools

or programs when negotiating with sites?



Ambulatory Costs and BBA Medicare Payments

Medicare

DME analog

MedicareIME

analog

Medicare GME*

Ambulatory Sites

35%

65%

68%

32%

infrastructure

direct

indirect



Medicare GME Payments for Non-Hospital TrainingThe Balanced Budget Act allows the Secretary of HHS

to pay GME costs to ambulatory sites based on their attributable and allocatable costs



Medicare GME Payments for Non-Hospital Training

A POTENTIALLY IMPORANT INCENTIVE:the BBA also allows residency programs to count residents

in ambulatory sites toward their IMEA payments IF the program and the site can agree in writing on the

site’s costs and payments



IF VALUE IS IN THE EYE OF THE BEHOLDER, WHOSE PERSPECTIVES ARE

IMPORTANT? payers patients clinicians/teachers clinical care organizations learners communities educational organizations

*Academic Medicine, October 1999


PAYERS’ VIEWS OF AREAS OF POTENTIAL VALUE ADDED BY

EDUCATION TO CLINICAL CARE influence future practitioners improved clinician recruitment & retention higher quality clinical care the direct labor of trainees improved clinician work satisfaction



THE VALUE COMPASSfrom clinical to education

EducationEducationClinicalClinical

CostCost

FunctionalFunctional

SatisfactionSatisfaction



Defining the Compass Points Clinical - signs & symptoms, test results, specific measures of

health status, educational status, or analogous situation

Functional - how well can the _________ do what it needs to do?

Satisfaction - how does the _________ react to the situation being assessed?

Cost - what are the financial and other costs that accrue to the ___________ in the situation being assessed?


OPERATIONALIZING THE EDUCATIONAL VALUE

COMPASS

EducationClinical

Cost

Functional

Satisfaction

teaching organizations

learners

the community

clinical care organizations

clinician/teachers

patientsin research and in your setting

SUMMING UP:WHAT HAVE WE DISCUSSED?

the costs of teaching are approximately the same in ambulatory sites as in hospitals, but the types of cost differ

Medicare makes substantial funds available for GME and provides an incentive for these to be shared between hospitals and ambulatory sites;

all involved gain benefits as well as pay costs when education takes place in ambulatory and other clinical settings

both gains and costs can be measured and should be taken into account as partnerships are developed

for more information, contact:

James R. Boex, MBADirector, Office of Health Services Organization & Research

Northeastern Ohio Universities College of Medicine

(330) [email protected]

understanding the costs and benefits of outpatient teaching gimgel session faculty development...

Documents

ambulatory costs

costs of ambulatory

understanding costs

gme costs

education costs allocatable

allocatable costs

space costs

clinical education