A Healthier Nevada
P R ESENTED BY: T R I P P U M BACH
9 / 2 9/14
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Introduction: Tripp Umbach
o Over the past ten years, Tripp Umbach has been
instrumental in 20 medical education expansion
projects throughout the United States.
o Since 1995 Tripp Umbach has measured the economic
impact of every U.S. medical school and teaching
hospital.
o Since 1990, Tripp Umbach has consulted with 75
academic medical centers, more than 500 hospitals,
and 250 universities in all 50 states.
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Medical Education Expansion Study Goals (2014)
The need for more doctors
in Nevada is so critical that
NSHE retained Tripp Umbach to:
o Develop a comprehensive business plan to
expand public medical education statewide at
both the undergraduate and graduate levels.
Overall Study Goal:
o Develop a new medical school at UNLV while
growing the existing University of Nevada School
of Medicine and expand GME statewide.
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the development of a
second public medical
school, expansion of
GME, physician
recruitment, and
retention efforts must
continue to produce quality
physicians that will remain
in the state, ensuring both
public health and economic
opportunity for all citizens.
Overview of Medical Education
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In the middle nineteenth century, it was easy to become
a doctor in America…
o Entrance requirements to medical schools were nonexistent other than the ability to pay
the fees.
o The standard course of instruction in the middle nineteenth century consisted of two 4month terms of lectures during the winter, with the second term identical to the first.
o Instruction was wholly didactic: 7 or 8 hours of lectures a day, supplemented by textbook
reading.
o Laboratory work was sparse, and even in the clinical subjects, no opportunity to work with
patients was provided.
o Examinations were brief and superficial; virtually the only requirement for graduation was
the ability to pay the fees.
o University or hospital affiliations, in the few cases in which they existed, were nominal.
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THREE PHASES of MEDICAL EDUCATION
“A Continuum”
Undergraduate Medical Education (UME)
o LCME (Liaison Committee on Medical Education)
Graduate Medical Education (GME)
o ACGME (Accreditation Council on Graduate Medical Education)
Continuing Medical Education (CME)
o ACCME (Accreditation Council on Continuing Medical Education)
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The Continuum: A Long-Term Investment
GME/Residency Training
Medical School
K-12
Education
Undergraduate/
College
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Patient Care
Education
Educational
Activities
“Medical Education”
Patient Care
Services
Balance
Research
Teaching
MEDICAL EDUCATION ACTIVITIES
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Graduate Medical Education (GME)
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Sponsoring Institution
o ACGME-accredited residency programs must operate under the authority and
control of a sponsoring institution. Hospitals, medical schools, or consortium
organizations may be sponsoring institutions.
o Has the primary purpose of providing educational programs and/or health care
services (e.g., a university, a medical school, a hospital, a school of public health, a
health department, a public health agency, an organized health care delivery
system, a medical examiner’s office, a consortium, an educational foundation).
o Retains responsibility for the quality of GME even when resident education occurs
in other institutions.
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Multi-Pronged Strategy for Developing & Expanding GME
Developing New University
Sponsored Programs
Expanding Existing University
or Hospital Based Programs
Potential GME
Strategies
Teaching Health
Centers/FQHC’s
Hospital Consortium (501c 3)
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Federally Qualified Health Centers (FQHC’s) –
Reasons to Collaborate
o Offers an attractive, unique training environment offering some of the best
and evolving models of care.
o Creates a dynamic clinical environment.
o Enhances the status/reputation of each party.
o Enhances physician recruitment and retention.
o Stepping stone to other collaborations.
o Financially and otherwise beneficial to parties and the community.
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GME Consortium (501 c 3)
o The development of a GME Consortium model would be where hospitals and other
organizations such as medical schools and public health agencies, partner to develop
residency programs and act as the vehicle to expand physician training in the region.
o Physicians in the future will deliver healthcare in close partnership with other health
professions, such as physician assistants, nurse practitioners, and allied health professionals, it
would also be the goal of the Consortium to stimulate interdisciplinary training opportunities
for a wide range of health professionals.
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Current GME Funding
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GME Economics 101
Income
from CMS:
Ranges from $50k Per
Resident to as High as
$180k Per Resident
% of Medicare in
Patient Load
Ratio of Hospital Beds
to Residents
The Balanced Budget Amendment of 1996, in which Congress froze federal funding
for established medical residency programs.
Current Funding Situation
o Although the federal government is the largest single supporter of graduate
medical education, overall support for GME comes out of a number of
separate public and private pots.
o The federal government, mostly via the Medicare program, currently
provides more than $11 billion per year in payments to support the training
of doctors who have graduated medical school.
o Newly accredited institutions have three years to develop their programs
before federal funding is capped.
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Uncertainty with GME Funding
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Current Funding Situation
o More than 40 states paid about $3.78 billion through their Medicaid
programs to support GME in 2009, this amount has dropped significantly in
the past 5 years as many states have reduced their support for advanced
medical training.
o Private insurers support GME to a lesser degree since the enactment of the
Affordable Care Act of 2010.
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Institute of Medicine (IOM)
o The IOM panel calls for spending the same overall funding from
Medicare over the decade, adjusted for inflation.
o Distributed much differently, with a declining share providing direct
subsidies to teaching programs.
o An increasing share would go instead to a “GME transformation fund”
that would finance new ways to provide and pay for training and fund
training positions “in priority disciplines and geographic areas.”
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In Nevada UME + GME = Doctors
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Benefits to Hospital Due to GME
o Recruitment Cost Savings Resulting From Graduating Residents
o Additional Hospital Operating Revenue (Profit) Generation Due to Graduated Residents
Practicing at Hospital
o Additional Hospital Operating Revenue (Profit) Generation Due to Specialty Physicians at
Hospital b/c it has GME
o Revenue from Quality Outcomes
o Savings from Lower Utilization in Emergency Department
o Image Enhancement in Key Program and Service Areas as a “Teaching Hospital”
o Expansion of Potentially Profitable Programs Due to Residency Accreditation Requirements to
Hire Additional Sub-Specialty Physicians
o Workforce that is Closely Tied with the Culture of Both Your Hospital and Your Community
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Making a Difference in the Community
The future benefits resulting from expanding both UME and GME include:
o expanding access for underserved populations;
o increasing the quality of healthcare;
o eliminating the need for Nevada citizens to go outside of the state for
healthcare;
o increasing economic development through the attraction of federal
and private research dollars; and
o attracting new industries who are drawn to regions with superior
healthcare that could eventually lead to Nevada being a destination for
advanced medicine.
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Making a Difference in the Community
o Through the expansion of UME and GME, an overall goal for the state of
Nevada is to create an atmosphere of innovation and excellence in research
and patient care where residents and fellows can fully realize their potential
as a highly competent physician, physician-scientist, clinical investigator, or
institutionally based academician.
o Ultimately, the goal is to enhance the current prestige of the existing
institutions and strengthen the new.
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Success
o As based on national averages, students who complete both their UME
and GME in Nevada have a better than 80% chance of remaining in the
state. Students that only complete GME in Nevada have a 60% chance
of remaining in the state.
o This is why the integrated NSHE driven process is so important.
The true success lies in developing pipelines, recruiting residents, and
retaining graduates to an educationally enriched region.
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