Project Option 1.9.1 Expand Specialty Care Capacity: EXPANDED RESIDENCY PROGRAM
Unique Project ID: 138951211.1.1
Performing Provider Name/TPI: The El Paso County Hospital District d/b/a University Medical Center of El Paso (UMC) / TPI: 138951211
Project Description:
This project will establish an ongoing rotation in El Paso for residents based at Texas Tech University Health Sciences Center (Texas Tech) in El Paso.
Under this project, UMC El Paso will assist Texas Tech in expanding the residency programs for several specialties, including Cardiology, Gastroenterology, Orthopedics, Nephrology, Family Medicine, and Radiology. This project will also assist Texas Tech in establishing residency programs in Maternal Fetal Medicine and Pelvic Floor Residencies / Fellowships. This project will require commitment of local specialists to specific teaching and administrative responsibilities, supported by faculty and resident stipends and other supportive resources provided by the hospital.
The project will involve the continuing assessment of El Paso’s needs for additional specialty providers and increased specialty services capacity in the identified specialties and other specialties. The project will increase the number of specialists in the El Paso community, and improve the specialty provider workforce, by improving specialty provider recruitment efforts; UMC will accomplish this primarily by offering additional residencies in El Paso, which will increase the likelihood of successfully recruiting new graduates to practice in the community. UMC will also conduct quality improvement activities as part of the expanded residency programs.
Goals and Relationship to Regional Goals:
Project Goals: The immediate goal of this project is to increase the annual number of program participants over the years of the Waiver. Another goal of this project is to provide positive exposure to opportunities in El Paso for these residents, thereby increasing the likelihood of successfully recruiting these new graduates to practice in this area.
This project meets the following regional goals: This project meets the regional goal of increasing the number of specialists and scope of services offered in the community. This project will increase specialty services by expanding residency programs for specialty areas of identified need, thus bringing more specialty providers to the region.
Challenges:
A limited number of local specialists are available to provide teaching support. Significant funding is required to support this new program. Federal funding (Medicare Direct Graduate Medical Education or DGME) for residency training is capped at 1996 levels for the direct support of graduate medical education. The cap only supports a third of the costs of 4,056 of the 4,598 actual positions in Texas, leaving the residency programs to cover the cost of two-thirds of the 4,056 positions and the full cost of 542 positions. Texas is currently over its Medicare cap by 13%.
5-Year Expected Outcome for Provider and Patients:
UMC expects this project to increase the capacity of specialty care services and the availability of targeted specialty providers to better accommodate the high demand for specialty care services, so that patients have increased access to specialty services. This will enable much-needed diagnostic testing and services for the unfunded and underfunded population.
Starting Point/Baseline:
At the inception of the Waiver, UMC had 181 residents participating in its programs in Anesthesia, Emergency Medicine, Family Medicine, Orthopedics, Radiology, and Psychiatry. New programs will begin in GI, Cardiology, and Nephrology. The baseline for this project will begin December 2011 to measure approved ACGME applications and additional enrollees into the program.
Rationale:
Inadequate access to specialty care has contributed to the limited scope and size of safety net health systems. To achieve success as an integrated network, gaps must be thoroughly assessed and addressed. This project is imperative because El Paso needs more local specialists so that patients will not have to travel long distances, endure long wait times, or receive lower quality care due to the shortage of specialists in the area. Residency programs require 3 to 8 years of training, depending on the specialty. Medicare funding only covers years 1 through 3. In 2011, Texas had more than 550 residency programs, offering a total of 6,788 positions. Only 22% (1,494) of these were first-year residency positions. According to the Coordinating Board, conservative estimates indicate that the cost to educate a resident physician for one year is $150,000. There is a great need for extended residency programs in Texas and, in general, an increase in the number of specialists.
Project Components: 1.9.1 Expand high impact specialty care capacity in most impacted medical specialties
The expansion of specialty residency programs at UMC El Paso will accomplish the following core project components (a-d):
a) Identify high impact/most impacted specialty services and gaps in care and coordination.
o UMC has already identified significant gaps with respect to residency programs in Cardiology, Gastroenterology, Orthopedics, Nephrology, Family Medicine, and Radiology.
o UMC will continue to assess the need for these and other specialty services in the El Paso community.
b) Increase the number of residents/trainees choosing targeted shortage specialties
o UMC will increase the number of residents and trainees in the targeted specialties by expanding the residency programs for these specialties.
c) Design workforce enhancement initiatives to support access to specialty providers in underserved markets and areas (recruitment and retention)
o UMC intends that these expanded residency programs will provide residents with positive exposure to opportunities in El Paso, increasing the likelihood that the residents can be successfully recruited to (and retained in) the El Paso community.
d) Conduct quality improvement for project using methods such as rapid cycle improvement. Activities may include, but are not limited to, identifying project impacts, identifying “lessons learned,” opportunities to scale all or part of the project to a broader patient population, and identifying key challenges associated with expansion of the project, including special considerations for safety-net populations.
o UMC will conduct quality improvement activities as part of the expanded residency programs.
Unique community need identification numbers the project addresses:
· CN-2: Secondary and Specialty Care
How the project represents a new initiative or significantly enhances an existing delivery system reform initiative:
This project will significantly enhance UMC’s efforts to train new specialty providers and recruit and retain them in the El Paso community. UMC currently offers residencies in some of the specialties with identified needs, but some of the specialties (i.e., GI, Cardiology, and Nephrology) do not have any dedicated residency programs at UMC. Because these new and/or expanded residency programs will increase the likelihood that new graduates will choose to practice their specialties in El Paso, this project will significantly enhance UMC’s ability to train, recruit, and retain new specialty providers to serve patients in the region.
Related Category 3 Outcome Measures:
OD-11 Addressing Disparities in Health Populations
IT-11.6 Other Outcome Improvement Target - TBD
Reasons/rationale for selecting the outcome measures:
Waiting on HHSC / CMS direction for residency projects. TBD
Relationship to other Projects: This project will complement UMC’s Establish Nurse Residency and Simulation Lab project (138951211.1.6); both projects will focus on improving access to specialty care in the El Paso community by training new physician and mid-level providers in an acute-care residency setting.
Relationship to Other Performing Providers’ Projects and Plan for Learning Collaborative: Providence and Sierra East are also developing projects to support the expansion of access to primary or specialty care in the community. TTUHSC is developing a project to enhance the residency programs available in El Paso.
Performing Providers, IGT entities, and the Anchor for Region 15 have held consistent monthly meetings throughout the development of the Waiver. As noted by HHSC and CMS, meeting and discussing Waiver successes and challenges facilitates open communication and collaboration among the Region 15 participants. Meetings, calls, and webinars represent a way to share ideas, experiences, and work together to solve regional healthcare delivery issues and continue to work to address Region 15’s community needs. UMC, as the Region 15 Anchor anticipates continuing to facilitate a monthly meeting, and potentially breaking into workgroup Learning Collaboratives that meet more frequently to address specific DSRIP project areas that are common to Region 15, as determined to be necessary by the Performing Providers and IGT entities. UMC will continue to maintain the Region 15 website, which has updated information from HHSC, regional projects listed by Performing Provider, contact information for each participant, and minutes, notes and slides from each meeting for those parties that were unable to attend in-person.
Region 15 participants look forward to the opportunity to gather annually with Performing Providers and IGT entities state-wide to share experiences and challenges in implementing DSRIP projects, but also recognize the importance of continuing ongoing regional interactions to effectuate change locally. Through the use of both state-wide and regional Learning Collaborative components, Region 15 is confident that it will be successful in improving the local healthcare delivery system for the low-income and indigent population.
Project Valuation
The valuation of each UMC project takes into account the degree to which the project accomplishes the triple aim of the Waiver, the degree to which the project addresses community needs, the acuity and number of patients served by the project, and the investment required to implement the project. This project also takes into account the costs and health complications that can be avoided when a patient population receives the right care in the right setting, rather than being forced to utilize the Emergency Department as its primary healthcare resource. This project will significantly address the needs of the El Paso community by increasing the capacity to provide specialty care services and the availability of targeted specialty providers to better accommodate the high demand for specialty care services so that patients have increased access to specialty services.
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138951211.1.1 / 1.9.1 / 138951211.1.9.1 / Expanded Residency Program /University Medical Center of El Paso / 138951211 /
Related Category 3 Outcome Measure(s):
OD-11 Addressing Health Disparities in Minority Populations / IT-11.6 Other Outcome Improvement Target - TBD / 138951211.3.1 / OD-11 Addressing Health Disparities in Minority Populations
IT-11.6 Other Outcome Improvement Target - TBD /
Year 2
(10/1/2012 – 9/30/2013) / Year 3
(10/1/2013 – 9/30/2014) / Year 4
(10/1/2014 – 9/30/2015) / Year 5
(10/1/2015 – 9/30/2016) /
Milestone 1 [P-14]: Expand targeted specialty care (TSC) training.
Metric 1 [P-14.1]: Expand the TSC residency, mid-level provider (physician assistants and nurse practitioners), and/or other specialized clinician/staff training programs and/or rotations.
Data Source: Documentation of applications and agreements to expand training programs
Milestone 1 Estimated Incentive Payment: $1,612,276
Milestone 2 [CQI P-19]: Participate in at least bi-weekly interactions (meetings, conference calls, or webinars) with other providers and the RHP to promote collaborative learning around shared or similar projects.
Metric 1 [P-19.1]: Number of bi-weekly meetings, conference calls, or webinars organized by the RHP that the provider participated in.
Baseline/Goal: n/a
Data Source: Documentation of weekly or bi-weekly phone meetings, conference calls, or webinars including agendas for phone calls, slides from webinars, and/or meeting notes
Milestone 2 Estimated Incentive Payment: $1,612,275 / Milestone 3 [P-16]: Obtain approval from the Accreditation Council for Graduate Medical Education (ACGME) to increase the number of TSC residents.
Metric 1 [P-16.1]: ACGME approval for residency position expansion.
Baseline/Goal: Obtain ACGME approval for 18 new TSC residency positions.
Data Source: Documentation of ACGME approval for residency position expansion.
Milestone 3 Estimated Incentive Payment: $1,758,906
Milestone 4 [CQI P-19]: Participate in at least bi-weekly interactions (meetings, conference calls, or webinars) with other providers and the RHP to promote collaborative learning around shared or similar projects.
Metric 1 [P-19.1]: Number of bi-weekly meetings, conference calls, or webinars organized by the RHP that the provider participated in.
Baseline/Goal: n/a
Data Source: Documentation of weekly or bi-weekly phone meetings, conference calls, or webinars including agendas for phone calls, slides from webinars, and/or meeting notes
Milestone 4 Estimated Incentive Payment: $1,758,906 / Milestone 5 [I-31]: Increase TSC training and/or rotations.
Metric 1 [I-31.2]: Increase the number of TSC trainees rotating at the Performing Provider’s facilities.
Baseline/Goal: Increase number of TSC residents rotating at UMC by 5% over DY1. (9 additional residents rotating at UMC)
Data Source: Student/trainee rotation schedule.
Milestone 5 Estimated Incentive Payment: $3,528,038 / Milestone 6 [I-31]: Increase TSC training and/or rotations.
Metric 1 [I-31.2]: Increase the number of TSC trainees rotating at the Performing Provider’s facilities.
Baseline/Goal: Increase number of TSC residents rotating at UMC by 10% over DY1. (another 9 additional residents rotating at UMC) for a total of 18 additional residents by the end of the Waiver term.
Data Source: Student/trainee rotation schedule.
Milestone 6 Estimated Incentive Payment: $2,914,466
Year 2 Estimated Milestone Bundle Amount: $3,224,551 / Year 3 Estimated Milestone Bundle Amount: $3,517,812 / Year 4 Estimated Milestone Bundle Amount: $3,528,038 / Year 5 Estimated Milestone Bundle Amount: $2,914,466
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD: $13,184,867
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