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Welcome
Teaching Health Centers: Seeking Accreditation
to Provide Graduate Medical Education
March 5, 2013
We will begin promptly at 1:00 PM EDT
Event Host:
Patrina Twilley, MSW
Research Assistant
National Health Care for the
Homeless Council, Inc.
This publication was made possible by grant number U30CS09746 from the Health Resources &
Services Administration, Bureau of Primary Health Care. Its contents are solely the responsibility of
the author and do not necessarily represent the official views of the Health Resources & Services
Administration.
Health Care & Housing Are Human Rights
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Teaching
Health Centers:
Seeking Accreditation
to Provide Graduate
Medical Education
March 5, 2013
Health Care & Housing Are Human Rights
Presenters
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Patrina Twilley,
MSW
Research Assistant
National Health Care for
the Homeless Council
Nashville, TN
[email protected]
Dr. Songhai Barclift,
MD, FACOG
Lieutenant Commander, USPHS
Chief Community Based Training
Branch/ Division of Medicine and
Dentistry
HRSA/Bureau of Health
Professions
[email protected]
Health Care & Housing Are Human Rights
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Learning Objectives
Describe at least
two benefits to
becoming an
accredited Teaching
Health Center
(THC).
Identify THC
accrediting bodies
that meet eligibility
requirements
through the HRSA
THCGME Program.
Discuss resources
available through the
Council and HRSA
to learn more about
the THCGME
Program.
Health Care & Housing Are Human Rights
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Webinar Outline
Overview of National HCH Council’s
survey of University and HCH
Collaborations
THCGME Program Overview: Dr.
Songhai Barclift
Q & A Session
Health Care & Housing Are Human Rights
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University and HCH Collaborations
Survey Purpose
n  Explore
collaborative relationships between medical/allied health
professional training schools and health centers that provide
services to individuals experiencing homelessness.
n  Learn
about factors that contribute to successful collaboration
between these two entities.
n  Identify
promising practices that can be attributed to successful
and sustainable collaborations with academic institutions that
are mutually beneficial.
+ University and HCH Collaborations
Survey Findings
Federal Funding Source
+ University and HCH Collaborations
Survey Findings
Collaborates with an Academic Institution
+ University and HCH Collaborations
Survey Findings
Length of Collaboration (In Years)
+ University and HCH Collaborations
Survey Findings
Are You a Teaching Health Center?
+ University and HCH Collaborations
Survey Findings
Characteristics of Relationship
n  Short
rotations (0-3 months)
n  Education
often requires an on-site preceptor
n 
HCH site provides on site preceptor
n 
Preceptor not compensated
n  Time
involved in providing educating to health
professions students: 1-5 hours each week
(most reported)
n  Students
receive academic credit, but no stipend
+ University and HCH Collaborations
Survey Findings
Benefits Collaboration Provides
+ University and HCH Collaborations
Survey Findings
Obstacles Experienced in Educating Students
n  Time
n  Staff
time
n  Loss of productivity
n  Students unprepared
n  Resources
n  Budget
cuts
n  Lack staff
n  Managing paperwork
n  Space constraints
n  Lack computer resources
+ What Does Seeking Accreditation as a
THCGME mean for HCH Sites?
n  Possible Advantages
n  Alleviate
financial burden in
educating residents
n  Demonstrate increases in health
center workforce development
n  Job retention among staff
n  Residents more likely to provide
care to underserved populations
n  Community benefits as a result
of improved health outcomes
and access to care
THCGME Program Overview
Dr. Songhai Barclift
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Lieutenant Commander, USPHS
Chief Community Based Training
Branch/ Division of Medicine and
Dentistry
HRSA/Bureau of Health Professions
[email protected]
Health Care & Housing Are Human Rights
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Teaching Health Center GME Program Na#onal Health Care for the Homeless Council, Inc. March 5, 2013 Songhai Barcli: MD., Branch Chief Department of Health and Human Services Health Resources and Services Administra#on Bureau of Health Professions 16
Affordable Care Act Teaching Health Center AuthorizaAon •  Sec. 5508 of Pa#ent Protec#on and Affordable Care Act, “Increasing Teaching Capacity” •  Components •  Sec#on 749A (Title VII), “Teaching Health Centers Development Grants” •  Sec#on 338C(a), “Na#onal Health Service Corps Teaching Capacity” •  Sec#on 340H (Title III), “Payments to Qualified Teaching Health Centers” 17
THC Program Impact •  Help address primary care workforce •  THC model has a long history with several successful THCs da#ng back to the 1980s (Engebretsen 1989, Zweifler 1993) •  Increased likelihood of THC graduates choosing to prac#ce in HCs/other underserved se[ngs (Morris 2008, Rieselbach 2010) 18
Common Elements of Successful THCs •  Commitment to a dual mission of medical educa#on and service to underserved •  Significant pa#ent-­‐ and community-­‐based input into THC opera#on and management •  Demonstrated progress toward innova#ve models of pa#ent care delivery 19
THCGME Eligibility •  New residents in a newly-­‐established THC or an expanded number of residents in a pre-­‐exis#ng residency •  “Community-­‐based, ambulatory pa#ent care se[ng” • 
• 
• 
• 
FQHCs/FQHC Look-­‐alikes Community mental health clinics IHS or tribal health centers Title X clinics 20
THCGME Eligibility •  “Operates a primary care residency program,” which, per the statute, includes: • 
• 
• 
• 
• 
• 
• 
• 
Family medicine
Internal medicine Pediatrics Medicine-­‐pediatrics Obstetrics-­‐gynecology Psychiatry General and pediatric den#stry Geriatrics 21
THCGME Eligibility •  Must be listed as the ins#tu#onal sponsor by the relevant accredi#ng body: •  Accredita#on Council for Graduate Medical Educa#on (ACGME) •  American Osteopathic Associa#on (AOA) •  Commission on Dental Accredita#on (CODA) •  Must be accredited or provisionally accredited at #me of applica#on 22
Residency – CHC Partnerships Residency Advantages: •  Supports increased supply of primary care physicians commieed to the underserved: •  minority and high risk groups •  rural, urban, global se[ngs •  Community-­‐based “real life” se[ng •  Financial stability with enhanced reimbursement •  Poten#al partner for other community ac#vi#es (community-­‐
based research, medical homes) 23
Residency – CHC Partnerships Health Center Advantages: •  Academic environment encourages evidence-­‐based, exemplary prac#ce •  Teaching o:en improves job sa#sfac#on, encourages reten#on •  Academic affilia#on enhances image with pa#ents, employees and funders •  Ul#mately, perhaps the best solu#on to workforce issues -­‐ Those who teach in HCs tend to stay there -­‐ Those who train in HCs tend to choose underserved se[ngs 24
TradiAonal GME Model Accredita#on Medicare GME $ Teaching Hospital/ Academic Health Center (inpa#ent) Residency Program (con#nuity clinic) Community Training Site 25
THC Model Hospital/ AHC Community Training Sites Teaching Health Center Residency Medicare GME $ CHC Accredita#on HRSA GME $ 26
Corporate EnAAes •  Corporate en##es may also be eligible THCs •  e.g. a GME consor#um collabora#ng with a health center and hospital in opera#ng one or more primary care GME program •  Must ensure that the community based ambulatory training site is a central partner in the consor#um •  THCGME payments must directly support the THC ambulatory training site 27
GME Payments to THC •  Can supplement but not duplicate other GME funding •  THC FTE does not count against hospital caps 28
GME Payments to THC •  FY 2011-­‐2015 Appropria#on: •  Up to $230 million •  Direct (DME) + Indirect (IME) •  Interim payment $150,000/FTE (un#l the IME methodology is determined) 29
Fiscal Year 2011 THCGME Awardees 1) 
2) 
3) 
4) 
5) 
6) 
7) 
8) 
9) 
10) 
11) 
Valley Consor#um for Medical Educa#on – Modesto, CA Family Medicine Residency of Idaho – Boise, ID Northwestern McGaw Erie Family Health Center – Chicago, IL Penobscot Community Health Center – Bangor, ME Greater Lawrence Family Health Center – Lawrence, MA Montana Family Medicine Residency – Billings, MT Ins#tute for Family Health, Mid-­‐Hudson – New York, NY Wright Center for Graduate Medical Educa#on (IM) – Scranton, PA Lone Star Community Health Center – Conroe, TX Community Health of Central Washington – Yakima, WA Community Health Systems – Beckley, WV 30
Fiscal Year 2012 THCGME Awardees 1) 
2) 
3) 
4) 
5) 
6) 
7) 
8) 
9) 
10) 
11) 
Choctaw Na#on Health Services Authority – Tulsa, OK Ins#tute for Family Health, Harlem – New York, NY Long Island FQHC—East Meadow, NY Osteopathic Medical Educa#on Consor#um of Oklahoma (FM) – Tulsa, OK Osteopathic Medical Educa#on Consor#um of Oklahoma (OB/GYN) – Tulsa, OK Osteopathic Medical Educa#on Consor#um of Oklahoma (PEDS) – Tulsa, OK Ozark Center– Joplin, MO Puyallup Tribal Health Authority – Tacoma, WA Tahlequah Medical Group – Tahlequah, OK AHEC West /University of Arkansas for Medical Sciences – Liele Rock, AR Yakima Valley Farm Workers Clinic (DENTAL) – Yakima, WA 31
Fiscal Year 2013 THCGME Awardees
1.  A-­‐Op#c – Pikeville, KY 2.  Connec#cut Ins#tute for Communi#es, Inc. – Danbury, CT 3.  Cornerstone Care, Inc. – Greensboro, PA 4.  Detroit Wayne County Health Authority (FM) – Detroit, MI 5.  Detroit Wayne County Health Authority (IM) – Detroit, MI 6.  Detroit Wayne County Health Authority (GERI) – Detroit, MI 7.  Detroit Wayne County Health Authority (PEDS) – Detroit, MI 8.  Detroit Wayne County Health Authority (PSYCH) – Detroit, MI 9.  Fresno Healthy Communi#es Access Partners – Fresno, CA 10.  Morton Comprehensive Health – Tulsa, OK 11.  Mountain Area Health Educa#on Center, Inc. – Asheville, NC 12.  Primary Health Care, Inc. – Des Moines, IA 13.  Shasta Community Health Center – Redding, CA 14.  Wright Center for Graduate Medical Educa#on (FM) – Scranton, PA 15.  Wright Center for Graduate Medical Educa#on/SOMA – Scranton, PA 16.  Yakima Valley Farm Workers Clinic (FM) – Toppenish, WA 32
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THC PUBLICATIONS 34
When is the next opportunity to apply? •  FY 2014 Funding Opportunity Announcement release date – TBD •  Technical Assistance calls prior to applica#on deadline 35
Contact InformaAon Songhai Barcli:, MD. Branch Chief Division of Medicine & Den#stry Bureau of Health Professions sbarcli:@hrsa.gov 301-­‐443-­‐8681 36
Q & A Session
+
Patrina Twilley,
MSW
Research Assistant
National Health Care for
the Homeless Council
Nashville, TN
[email protected]
Dr. Songhai Barclift,
MD, FACOG
Lieutenant Commander, USPHS
Chief Community Based Training
Branch/ Division of Medicine and
Dentistry
HRSA/Bureau of Health
Professions
[email protected]
Health Care & Housing Are Human Rights
37
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Resources
n  Broderick, P.W., Nocella, K. (2012). Developing
a CommunityBased Graduate Medical Education Consortium for Residency
Sponsorship: One Community’s Experience. Academic
Medicine. 87(8): 1096-1100.
n  Chen, C., Chen, F., and
Mullan, F. (2012). Teaching Health
Centers: A New Paradigm in Graduate Medical Education.
Academic Medicine, 87(12): 1752-6.
n  Nasca, T.J. and
Brigham, T.P. (2012). Commentary: The Modesto
Story: Back to the Future? Academic Medicine, 87(8): 996-8.
n  HRSA Teaching
Health Center Website:
http://bhpr.hrsa.gov/grants/teachinghealthcenters/index.html
n  National
HCH Council (2013). Teaching Health Centers: A
Case Study – release TBA
Health Care & Housing Are Human Rights
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