Medical Schools and Teaching Hospitals Add Billions to U.S. Economy – “The Economic Impact of Publicly Funded Research Conducted by AAMC-Member Medical Schools and Teaching Hospitals.”

Federal- and state-funded research conducted at the nation’s medical schools and teaching hospitals in 2009 added nearly $45 billion to the nation’s economy, according to a new study by the national economic consulting firm Tripp Umbach conducted for the AAMC (Association of American Medical Colleges). In addition, the study found that medical research conducted at AAMC-member institutions supports nearly 300,000 or 1 in 500 U.S. jobs.

“The value of research has always been clear—medical research means hope to patients and improves the health of all Americans,” said AAMC President and CEO Darrell G. Kirch, M.D. “Through this study we also can see how important this work is as an economic driver, funneling billions into the economy and providing hundreds of thousands of high-skilled jobs as well as indirect employment in communities around the country.”

Speaking today at the AAMC’s annual meeting, Francis S. Collins, M.D., Ph.D., director of the National Institutes of Health (NIH) reinforced the importance of that institution’s research to the fiscal health of the nation. Physicians and researchers at AAMC-member institutions are awarded more than half of all NIH grants to external scientists.

“AAMC’s commissioned report demonstrates that NIH’s investment in biomedical research continues to have a positive effect on the health and economy of the nation,” said Collins. “Research conducted at medical schools and teaching hospitals is a critical source of knowledge that advances the NIH mission to enhance health, lengthen life, and reduce the burdens of illness and disability.”

“Sustained federal funding is vital to the continued progress of medical research and the discovery of new cures and treatments,” said Ann C. Bonham, Ph.D., AAMC Chief Scientific Officer. “The Tripp Umbach study shows that federal- and state-funded research also provides jobs and economic growth that contributes to the stability of the U.S. economy.”

Download the full report: The Economic Impact of Publicly Funded Research Conducted by AAMC-Member Medical Schools and Teaching Hospitals

2. Update from the Accreditation Council for Graduate Medical Education (ACGME):

2.1. The Potential Impact of Reduction in Federal GME Funding in the United States: A Study of the Estimates of Designated Institutional Officials - October 20, 2011

Thomas J. Nasca, M.D., MACP, Rebecca S. Miller, M.S., Kathleen D. Holt, Ph.D.

The Accreditation Council for Graduate Medical Education. Chicago, IL.

http://www.acgme.org/acWebsite/home/ImpactReductionFederalGMEFundingTJN.pdf

Introduction

As a result of the decisions made in the Summer of 2011 to increase the federal debt limit of the United States, the Joint Select Committee on Deficit Reduction (the “Super Committee”) was formed to recommend to the Congress by December 2011 reductions in federal spending to be accomplished over the next 10 years. Among the entitlement program elements being examined by the Super Committee, Medicare reimbursement for Graduate Medical Education (GME), the primary source of GME funding in the United States, has been identified as an opportunity for spending reductions. Specifically, the Medicare Payment Advisory Commission (MedPAC) has indicated that approximately 50% of the Indirect GME Reimbursement is not ”empirically justified” on the basis of current costs of teaching hospitals intended to be covered by that reimbursement. This is seen by many as an opportunity for reduction. Furthermore, the Simpson-Bowles Commission -- The National Commission on Fiscal Responsibility -- recommended a reduction in total GME funding in excess of 50% ($60 billion over 10 years) as a component of a comprehensive strategy to reduce federal deficit spending.

This discussion occurs in the context of a predicted physician shortage, a mounting surge in the number of domestic graduates of schools of allopathic and osteopathic medicine designed to remedy that anticipated physician shortage v , and slow growth in GME output over the past decade iv. However, this increase in medical school output must be accompanied by an increase in Graduate Medical Education, which is the required final pathway to entry into the unsupervised practice of medicine in the United States. As the body charged by the public and the profession with accreditation oversight of the vast majority of the GME programs in the United States, and to measure the quality of educational opportunities for physicians as they seek to prepare to meet the needs of the American public, the Accreditation Council for Graduate Medical Education (ACGME) attempted to estimate the impact of reductions in GME funding of the magnitude under discussion in our nation’s capital on the educational pipeline for physicians.

Methods

The ACGME contacted all Designated Institutional Officials (DIOs, respondents) (n=680) of ACGME accredited residency and fellowship programs through direct e‐mail on August 16, 2011, and requested that they complete an 18 question survey. Reminder e‐mails were sent at approximate 2 week intervals, and the survey closed on September 16, 2011. The 2 reminder emails urged all sponsoring institutions to participate and stressed the importance of each DIO’s response. Programs were assured that individual institutional responses would not be disclosed.

A 128‐bit secured web site, which ensured the safe transfer of information, provided access to the survey. The survey consisted of 12 forced choice questions and 6 open ended questions. The questionnaire is attached to this article in an Appendix. While the reporting window remained open, the DIOs could change their responses at any time. This permitted review of the questions with other institutional leadership before committing to the final submission.

The survey asked DIOs to indicate how future federal funding would affect their institutions’ programs and positions. Three different funding scenarios were presented: funding to remain stable at 2011 levels, funding to be reduced by 33%, and funding to be reduced by 50%. DIOs were asked to identify the potential impact on programs and positions under each scenario.

Data gathered in the survey were combined with other information (such as size, location, number and type of programs sponsored), and these were used in the analyses.

To assess the scope of program closures and reduction in positions in each of the three scenarios, we weighted the responses numerically. “Slight reductions” were calculated at 10% reduction; and “significant reductions” at 33%. If sponsors indicated they would close all sponsored programs, we assigned a weight of 100% to estimate position reductions. This process allowed us to apply the DIOs’ responses to the individual configuration of their particular institutions. Finally, data from respondents were extrapolated to non‐responders based on the type of institution (multi‐site and single site sponsors), to assess the total impact of funding reductions nationally.

Results

We received complete responses from 306 (45% response rate overall) sponsoring institutions; 236 respondents were from multi‐site sponsors, representing a 61% response rate in that group. The 306 respondents represent 68.9% of all accredited programs, and 68.4% of all resident positions in the United States in academic year 2011. 118 respondents indicated that their sponsor is a university‐based institution. Nearly all responding DIOs (94.8%) indicated that they have been following the discussions in Washington DC regarding reduction in GME funding. The results of the survey can be seen graphically in Figures 1 and 2.

Impact on the number of accredited programs and their positions: stable funding

Were GME funding to remain stable at 2011 levels, the majority of responding sponsors (61%) would sponsor the same number of core (also known as “specialty”) and subspecialty positions. Additionally, 77.5% of these sponsors would keep the same number of core programs and 62.4% would sponsor the

same number of subspecialty programs. While very few responding sponsors (1.6%) would close subspecialty programs, 26.8% indicated that they would increase the number of subspecialty programs. Under this “stable” scenario, a minority of responding sponsors would increase the number of core residency programs (17.0%) and residency positions (30.1%) sponsored. No sponsor reported that they would close core residency programs.

Impact on the number of accredited programs and their positions: 33% reduction

Under this scenario, a majority of responding sponsors (68.3%) would slightly or significantly reduce the number of core residency positions and 60.3% would reduce the number of subspecialty fellowship positions. With this level of funding reduction, 4.3% of responding sponsors would close all core residency programs and 7.8% would close all subspecialty programs. These sponsors represent 339 programs (102 core and 237 subspecialties) and 3934 positions (2783 core and 1151 subspecialty positions). While the number of affected core residency programs is smaller than that of subspecialty programs, the majority of positions lost would be in core residency programs. Of the core residency positions lost, the majority would be in the medical specialties (59.5%).

Impact on the number of accredited programs and their positions: 50% reduction

With a 50% reduction in funding, 82.3% of responding sponsors would slightly or significantly reduce the number of core residency positions, and 76.2% would reduce the number of subspecialty fellowship positions. With this level of funding reduction, 14.0% of responding sponsors would close all core residency programs and 20.9% would close all subspecialty programs. These sponsors represent 538 programs (193 core and 345 subspecialties) and 6630 positions (5003 core and 1627 subspecialty positions). Again, the medical specialties would be most affected (3037 positions).

2.2. ACGME releases 2010-2011 Data Resource Book

http://www.acgme.org/acWebsite/newsReleases/newsRel_9_12_11.asp

The Accreditation Council for Graduate Medical Education Data Resource Book Academic Year 2010-2011 has been posted on the ACGME website. The 96-page publication can be viewed and downloaded for free at www.acgme.org/databook. This year's book features 2010-2011 (academic year July 1, 2010, to June 30, 2011) and long-term trend data on residents, programs and participating sites. In addition, the Data Resource Book includes information on program director turnover, as well as information on the geographic distribution of programs.

Highlights from 2010-2011 Data Resource Book include the following statistics:

□   In the 2010-2011 academic year, 113,142 residents were enrolled in 8,887 residency programs.
□   Six hundred and eighty-four institutions sponsored residency programs and residents had rotations at 3,968 sites.
□   The largest percentage of residents, 24%, were enrolled in internal medicine programs, followed by family medicine (10%) and pediatrics (8.8%).
□   The average cycle length for currently accredited programs is 4.3 years with more than 98% of programs receiving full or initial accreditation status.
□    The number of residents completing all accredited training increased from 28,983 in 2001-2002 to 35,594 in 2009-2010.

3. Update from the American Hospital Association Resource Center:

Hospital Survey on Patient Safety Culture: 2011 User Comparative Report Database (October 17, 2011)

When it comes to patient safety culture, most hospitals report their strongest areas relate to teamwork within work units and supervisor/manager expectations and actions promoting safety. Areas identified with the most potential for improvement are non-punitive response to error, hand-offs and transition, and the number of reported events. These are the findings from an analysis of hospitals using the Agency for Healthcare Research and Quality’s assessment tool, Hospital Survey on Patient Safety Culture.

The responses from over 1000 hospitals that have used the survey are available in an online comparative database report. The report allows hospitals to compare their survey results with other hospitals and provides data to identify their strengths and areas for improvement. Since AHRQ has been collecting the survey data since 2007, time trending data is also available. The data is analyzed by hospital characteristics [bed size, teaching status, ownership type, geographic region] and by respondent characteristics [work area/unit, staff position, and patient interaction level].

The survey database report includes data on 42 measures in 12 key areas of patient safety culture:

Communication openness
Feedback and communication about error
Frequency of events reported
Hand-offs and transitions
Management support for patient safety
Non-punitive response to error
Organizational learning and continuous learning
Overall perceptions of patient safety
Staffing
Supervisor/manager expectations and actions promoting safety
Teamwork across units
Teamwork within units

Source: Sorra J and others. Hospital survey on patient safety culture: 2011 user comparative database report. Agency for Healthcare Research and Quality, 2011. http://www.ahrq.gov/qual/hospsurvey11/

Sorra J and others. Nursing home survey on patient safety culture: 2011 user comparative database report. Agency for Healthcare Research and Quality, 2011. http://www.ahrq.gov/qual/nhsurvey11/

Respectfully submitted by Rimma Perelman, Chair of Political Action Committee, BQSIMB

November 7, 2011

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