Comprehensive Revenue and Expense Data Collection Methodology for Teaching Health Centers: A Model for Accountable Graduate Medical Education Financing

Abstract

Background: Despite considerable federal investment, graduate medical education financing is neither transparent for estimating residency training costs nor accountable for effectively producing a physician workforce that matches the nation's health care needs. The Teaching Health Center Graduate Medical Education (THCGME) program's authorization in 2010 provided an opportunity to establish a more transparent financing mechanism.

Objective: We developed a standardized methodology for quantifying the necessary investment to train primary care physicians in high-need communities.

Methods: The THCGME Costing Instrument was designed utilizing guidance from site visits, financial documentation, and expert review. It collects educational outlays, patient service expenses and revenues from residents' ambulatory and inpatient care, and payer mix. The instrument was fielded from April to November 2015 in 43 THCGME-funded residency programs of varying specialties and organizational structures.

Results: Of the 43 programs, 36 programs (84%) submitted THCGME Costing Instruments. The THCGME Costing Instrument collected standardized, detailed cost data on residency labor (n = 36), administration and educational outlays (n = 33), ambulatory care visits and payer mix (n = 30), patient service expenses (n = 26), and revenues generated by residents (n = 26), in contrast to Medicare cost reports, which include only costs incurred by residency programs.

Conclusions: The THCGME Costing Instrument provides a model for calculating evidence-based costs and revenues of community-based residency programs, and it enhances accountability by offering an approach that estimates residency costs and revenues in a range of settings. The instrument may have feasibility and utility for application in other residency training settings.

Figure

Data Captured in the Teaching Health Center Graduate Medical Education Costing Instrument ^a Except for resident recruitment costs, orientation programs, retreats, and graduation, which are disallowed from Medicare direct graduate medical education payments, residency expenses in table align with the Institute of Medicine report. ^b Programs reported payer mix using the categories in the Uniform Data System.