Texas A&M Health Science Center Education, Service, Research

1. Texas A&M Health Science CenterEducation, Service, Research Medical Education in Texas October 12, 2012 1

2. Serving Communities Across Texas 2

3. Texas A&M HSC Projected Growth:Growing to meet the needs of Texans

4. The Texas A&M HSC: Excellence in Education Across Texas • Bryan-College Station/Temple/Round Rock: College of Medicine led the state’s medical schools with a 99% passage rate on the national medical licensing exam in FY2012 • Kingsville: The Rangel College of Pharmacy has the highest percentage of Hispanic student enrollment in the U.S. • Dallas: Baylor College of Dentistry has the nation’s most diverse dental school student body • Bryan and Round Rock: The College of Nursing routinely leads the nation in licensure pass rates of graduates 4

5. Medicine at HSC-Round Rock • The College of Medicine began providing clinical training to medical students in Round Rock in April 2008, less than one year after receiving funding • In 2012-2013 academic year: 71 medical students in Round Rock • 34 third-year and 37 fourth-year students • Students complete rotations in family and community medicine, obstetrics and gynecology, internal medicine, pediatrics, psychiatry, and surgery • Began the first residency program in General Preventive Medicine in Summer 2012

6. Community-basedMedical Education Model • Utilizing a clinical faculty composed primarily of local physicians • Approximately 465 local physician faculty members in Round Rock • Partnering with the medical community to recruit needed specialists and expand access to care • Clinical rotations at St. David’s, Seton, Scott & White, Lone Star Circle of Care, Austin State Hospital, Dell Children’s Medical Center, and other sites 6

7. Pharmacy at HSC-Round Rock Rangel College of Pharmacy based in Kingsville: • Students complete three years of study in Kingsville, then travel to locations throughout South Texas and at other HSC campuses for one year of clinical training • Nine pharmacy students are scheduled to rotate through Round Rock during the 2012-2013 academic year • Clinical pharmacy rotations in place at St. David’s, Seton, and Scott & White

8. Nursing at HSC-Round Rock • Second Degree Bachelor of Science in Nursing (B.S.N.) track • Complete upper-division nursing curriculum in 15 months and obtain B.S.N. degree • Registered Nurse (R.N)-to-B.S.N. track • For registered nurses with associate degrees or diplomas; primarily an online program • 20 nursing students enrolled in Second Degree B.S.N. program in Round Rock this fall • 21 R.N.-to-B.S.N. students completing online coursework • Articulation agreement with ACC

9. When the State Invests in Health Care Education, Communities Benefit • TAMHSC revenue resources in FY2011 = $217 million (state investment: $115.2 million) • Total economic impact for Texas = $1.34 billion. • Round Rock campus economic impact in FY2011 = more than $48 million • Recruitment of professional workforce • Enhancement of health care delivery 9

10. College of Medicine Expansion:A rapid, cost efficient response to the physician shortage Catalyzed by legislative special item support COM added 120 first-year student slots from 2006-2011, at the lowest cost per new student of all Texas expansions. • Reached the goal of 200 entering students in 2011 • Expanded affiliated first-year GME positions by 30% since 2004 • Expanded Temple & College Station campuses to four-year campuses, and added Round Rock & Dallas clinical education programs 10

11. U.S. Physician Shortage: A Growing Problem 11

12. Texas Faces a Serious Doctor Shortage: 42nd in Physicians Per Capita 12

13. The Fastest Growing College of Medicine In the U.S.

14. GME in Crisis: The Coming Train Wreck 14

15. College of Medicine GME Partnerships • Temple • Scott & White Healthcare and • Central Texas Veteran’s Health System • 38 Residency and Fellowship programs with 2 more in approval process • Killeen • Darnall Army Medical Center • Family Medicine program • Emergency Medicine program • Bryan-College Station • St. Joseph Regional Health Center and College Station Medical Center • Family Medicine program Killeen Temple Bryan-College Station Round Rock Houston • Houston • Memorial Hermann Hospital Sugar Land • Family Medicine program • Round Rock • Preventive Medicine program Corpus Christi • Corpus Christi • Driscoll Children’s Hospital • Pediatrics program • CHRISTUS Spohn Health System • Family Medicine program 15

16. Nationwide - Med School Grads vs. GME Slots Actual & projected medical school graduates entering GME training positions, compared to scenarios of available positions (2001–2020) 16

17. 17

18. 18

19. GME Finances • Cost: $100,000/year/resident • Funding Sources: • Medicare • VA • DOD • Medicaid/Other state • Clinical revenue 19

20. Funding Streams for Medical Education Current GME estimated $100,000/resident/year ** UME approximately $100,000/student/year* State GME Formula Funding Hospital Operations Department of Veterans Affairs State funding by formula $40,000 Other funding sources Medicare DME $35,000 Medicare IME $45,000 Tuition & Fees $17,000 *Average total cost per student across all HRIs = $100,929 **$100-200K depending on source The rapid and necessary production of new physicians requires growth in both undergraduate and graduate medical education. Nationwide, medical school growth has far outpaced that of graduate medical education and is creating a crisis. New, sustainable funding sources are needed to create more than 120 new first-year GME positions to retain current Texas medical graduates and address our state’s growing physician shortage. New GME estimated $100,000/resident/year ** State GME Formula Funding Hospital Operations Medicare DME Medicare IME Department of Veterans Affairs Medicare is the primary payer for GME; major cuts are expected in FY2013. MedPAC, CBO, and the Simpson-Bowles Commission have suggested 60% cuts, which would destroy the country’s residency programs and our means for training the worlds’ best physicians.

21. Medicare Has Historically Paid For GME Direct Medical Education (DME) payments cover the direct cost of GME such as salary and fringe benefits for residents, and salaries and fringe benefits for faculty=$3B Indirect Medical Education (IME) payments cover expenditures such as the cost of treating more severely ill patients and the expenses of maintaining the latest in medical technology needed for training =$6.5B 21

22. The Cap and the Gap • Number of federally funded GME positions was capped by BBA of 1996 • There is a gap of between the sources of revenue supporting GME and institutional training costs • Direct Costs= $10B; Medicare DME=$3B • Indirect Costs=$27B; Medicare IME=$6.5B 22

23. 23

24. Federal Budget Discussions • The Bowles-Simpson deficit reduction commission recommended • Cutting DME and IME payments by more than 50% • Decreasing funding is coming at a time when ACA is increasing demand for health care services 24

25. Historical State Support • State funding for GME reached a high water mark of $188M in 2002-03 • State funding methods • Medicaid payments to teaching hospitals, $127M eliminated in 2002-03 • Funds trusteed to THECB • Special item and special funding programs • Formula funding (per resident payment) est. in 2006-07 25

26. Declining State Support • State Funding Cuts • Per capita formula funding cut $25M from $6,600 per resident per year to $4,400 (overall funding down from $79M to $54M). • THECB family medicine residency funding cut by $15.6 million (from $21.2M to $5.6M) • THECB Primary Care Residency Program ($5M) zeroed out • THECB GME Program ($600K) zeroed out • Physician Loan Repayment Program cut by $17.7 million (from $23.3M to $5.6M) • Total cut of 50% (from $130 to $65 million) in 2012-13 26

27. How Can We Avoid the Train Wreck? • Medical schools and hospitals should be urged to do everything possible to create new slots, but state and federal support is vital. • Creation of a viable funding mechanism to support expansion of existing residency programs and creation of new programs is vital to insure enough slots are available to retain Texas’ medical school graduates. 27