Optimizing GME Pass Through Reimbursement for

Transcript:Optimizing GME Pass Through Reimbursement for:
Optimizing GME Pass Through Reimbursement for Residency Training Programs Thomas W. Woller, M.S., FASHP Senior Vice President, Pharmacy Services Aurora Health Care Milwaukee, Wisconsin Disclaimer ASHP and Mr. Woller provide general information on the subject matter of GME pass-through funding mechanics. This information is not meant to substitute for your own research into applicability to obtain GME pass-through funding at your organization, a thorough review of direct and indirect costs associated with GME pass- through funding, or a discussion with your finance office. Overview of Presentation Program justification Non-CMS funding sources Medicare pass through basics Medicare pass through rules Pass through example Areas for optimization Potholes and audits Scenarios Residency Programs Justification CMS GME reimbursement Direct and indirect Non-CMS funding sources Staffing Projects/services Qualitative benefits Enhance overall teaching Challenge staff to excel Recruitment advantage Non-CMS Sources of Residency Funding States (historically Texas, Minnesota) VA Hospitals Colleges of Pharmacy Pharmaceutical Industry Hospitals and Health Systems Note that PGY-2 programs are not eligible for pass-through funding Department of Defense ASHP Foundation, NACDS, other organizations Others Other Contributions by Residents Projects to improve quality of care New services Provision of patient care Participation in the teaching of Pharm.D. students Cost reduction strategies Learning environment Recruitment Staffing Staffing Contributions of Residents 6 residents in the example 2 shifts every other weekend (1.2 FTE) Not quite 1.2 FTE due to training Replace pharmacists on the schedule Pharmacist average salary $120,000 + FB (30%) Value of resident staffing = $187,200 Careful with this justification; finance might want to reduce your RPh allotment correspondingly Medicare cost report basics All Medicare certified hospitals are required to file a cost report annually Filed with a fiscal intermediary or Medicare Administrative Contractor (MAC) History of cost reports adds to confusion Intended to define allowable costs and the “share” of those costs to be covered by the federal government Subject to review and audit by MAC In contemporary terms, most reimbursement by Medicare is determined through means other than the cost report; Direct Medical Education remains as an element determined through the cost report Medicare funding of pharmacy residencies Direct costs of medical education are excluded from operating costs under PPS and other payment provisions Reimbursement is on a reasonable cost basis COBRA 1986 changed Medicare payment for medical, dental, osteopathic and podiatry residencies; Not pharmacy and other paramedical programs Pastoral care, ultrasound, rad tech, etc. Indirect costs are also reimbursed;