GME Break-out Group
Service Models for Uncovered Patients
Who will pick up coverage needed?
· Self-study of GME program should be done to determine needs & cost
· May need to revise traditional resident mix for covering services
· Can internal moonlighting be utilized? New requirements may limit.
o Suggestion: “Moonlighting” redefined as “Defined Elective”, potentially with some additional reimbursement.
It will be important to identify appropriate workload of services: First, set caps on the number of patients that can be covered per resident per service under the new requirements – Is that feasible? RRCs may do this (Internal Medicine, for example) and other RRCs may choose to also address.
May require flipping the traditional PGY 1 to PGY 3 education/service roles (i.e. Traditional responsibility for call may need to be pushed from PGY 1 upwards to PGY 3 where it is no longer light/non-existent.) Standard hierarchy may shift. Anticipate current PGY2s and 3s will be unhappy as they will feel they have already paid their dues!
Educating Administration:
· No longer a GME issue.
· Need to work together to find solutions.
· Need to insure that everyone is working within scope of practice.
· Must make a business case.
· Are there available dollars? (For instance, adding attending supervision may allow billing for admissions, hospital days, and procedures that right now are being left on the table — without attending presence, these are items that are not being billed; so at least some of the costs of greater attending presence may be recouped by billable opportunities.
· What can we learn from services that have already had to have done this: in-house OB faculty for Labor and Delivery.
· Need to determine the cost of teaching medical students (residents usually contribute greatly) and have a way this is recognized, reimbursed.
· Need to encourage greater standardization across the institution (supervision, hand offs, transitions of care, etc).