We are planning to develop a Rural Training Track and need to develop a job description for a Family Physician who will plan and implement the project. Would you or a colleague have such a job description. Would appreciate any help
The RTT can be run by an outsider in the medical community, but it takes longer to develop, especially from scratch. Too many favors need asking of all the talks, rotations, etc.
Best to have sites where you can find overwhelming support for the concept from the medical staff and a person who is willing to give up half time or more to the project to get it up and going. We have had RTT directors that have started, then balked at giving up much clinical practice. We have had one leave suddenly and had to replace from an outsider. By far the easiest process was in Scottsbluff where the hospital, the hospital network, the medical staff were very supportive. We worried whether things would gel. Finally an established FP in the area committed to the project and within a year the foundation was laid and next year the first resident started in Omaha and is now in Scottsbluff.
In retrospect, better to pause at this phase and wait for someone to commit from internal rather than force someone or get impatient and bring in someone from the outside, if possible.
Criteria for RTT director - same as for program director, no difference in job descriptions. Choice of program director, find one with as few deficiencies as possible in the following priority:
1. interpersonal skills
2. local leadership/ not too amiable that he or she can't ask for favors
3. loves teaching
4. doesn't mind the extra work, passion for fp
5. willing and able to go to RAP (get started), Program Directors (maintain and explore), Student Res conf (recruit and learn about students)
6. administrative/management skills (assuming home program can help)
7. Availability to recruit
8. people to share call with
Most of this applies to the larger rural towns where we have RTT sites at about 20,000 pop and about 10-12 pc docs. Smaller sites we couldn't get by the RRC several years ago, but I suspect it is even more critical to find the right site and doc. Interesting how the same types of things apply to rural hospital administrators. Rarely do they have all the skills needed. Just pick the one with the least deficiencies. Given time the right folks can be teamed together to meet needs. Of course networking is helping rural hospitals cover these now.
We have two rural training tracks and most of the PG2 and PG3 years are
spent at two rural hospitals (one with 35 beds and the other with 50 beds).
No other residency training programs exist at these hospitals. It is my
understanding that these hospitals can not meet current Medicare criteria
for designation as teaching institutions and can not receive indirect GME
funds. Direct GME is possible if the resident is paid through another
designated teaching institution as part of another program.
Has anyone been successful at getting GME funding for their rural tracks?
If so was it IME, DME, or both?
You can receive direct GME. The IME is dependent on whether the hospital is
a sole community provider. If it is, you cannot receive IME and if it is
not, you can. The reasons for this are obscure, we are trying to get a
comment from our FI on the relevant regs. I am also forwarding your inquiry
to our administrator who is well versed and well frustrated by this issue,
in case she can help you more directly.
My hospital is still fighting for GME funding for my rural training program.
All but 2 months of PGY-2/3 are in our hospital, which is a 150 bed
hospital. We've been trying since 1996.
Our rural training track was implemented July 1, 1998. In spite of early
contacts with our fiscal intermediary in August of 1997, we did not get
clarification of our IME, DME funding until April of 2000. We fell in the
no-man's land between BBA 1997 and the BBA revision this past year, which
became effective for programs beginning April 1, 2000. Clarification
occurred only after extensive conversations with our FI, with the regional
HCFA office, through extended consultation and letters from Ernst & Young
(our hospital auditors), after conversations with our sponsoring institution
and a year-and-a-half negotiation of an affiliation agreement with them,
...and probably wouldn't have happened at all if I hadn't enlisted the
assistance of the congressional offices of our two state Senators and one US
Congressman. We are now getting DME funds as of May and have been told that
we will recoup direct cost reimbursement for the first 6 months of the
program when the hospital gets final reconciliation for fiscal year 1998
(probably some time in the next 11 months).
Our rural hospital (~65 active beds plus a Transitional Care Unit) claims
the residents for the time they spend in the hospital, based on quarterly
time studies. Our sponsoring institution, OSU Medical Center, counts the
residents for the time they are in the FPC and other community preceptors'
offices, all of which qualify under HCFA as "nonprovider settings."
Even now, it is not clear how our HCFA intermediary will respond to our
hsopital's cost report each year, especially as we ramp up to a full
complement of 4 residents, 2 each in the 2nd and 3rd year, and what our
"base year" amount will be. I'm not holding my breath and fully anticipate
it will require diligence and hard work on my part to see it through. Our FI
has pretty much relied on me and my NIPDD training to guide the hospital
through this, and this puts me in a very enviable position, according to
many other program directors I know. Anyone running a rural track should
feel free to contact me for advice and I would be happy to help.
Unfortunately, the application of the HCFA rules are very carrier-specific,
and what happens in Ohio may not apply in Montana. (I never heard of the
"sole provider" clause,!)
Obviously this has been a chronic problem for all RTTs. The responses have been
very interesting. DME should be no problem. It is an add on to the rates that
the hospitals charge Medicare and they should be able to get reimbursed. IME is
usually the problem. Medicare has a requirement that the hospital be a teaching
hospital which requires 3 residency programs for the designation. Some
hospitals have resolved this by a partnership with a larger urban hospital but
we have not been successful here in WNY. RAP of the AAFP has consultants on Medicare GME reimbursements which have
helped some institutions.