Louis J. Ling - Chair, Timothy Gaspar, Emily McGrath (for Kirsten J. Libby), Larry Kuusisto, Marilyn Speedie, John Abenstein, Byron Crouse, James R. Davis, Morris Davidman, Daniel D. Foley, Carl Patow, Sandra R. Edwardson, Jim Kohrt, Peter Rapp, Kathleen Meyerle, and Gary Anderson (for Peter Polverini).
Interested Parties Present:
Ben Bornstein, Jerry Collingham, David Edwards, Stacey Jassey, Colleen Storino, David Herman, Michele Olson, Anna Geary, Gerhardt Meier, Roger Balagot, Tiffany Schmidt, and Mark Huber.
MDH Staff Present:
Scott Leitz, Tom Major, Diane Marty, Diane Rydrych, and Michelle Strangis.
Tour of the Mayo Facilities:
Prior to the start of the Advisory Committee meeting, several Advisory Committee members attended a tour of the Mayo facilities. The tour included a walk through of St. Mary's Hospital, including such areas as surgery, ICU, pathology, and a newly built meditation area. The tour also highlighted new computerized technologies for charting, pharmacy/medication distribution, digitizing x-rays, etc.
I. Welcome from Mayo Clinic - Dr. Clarence Shub, Chair - Mayo Clinic Rochester Education Committee:
Dr. Shub gave a presentation of statistics related to Mayo's graduate medical education programs and medical school, along with the make-up of the faculty.
Dr. Ling announced that Dr. Michael Till has retired from the University of Minnesota School of Dentistry and the MERC Advisory Committee. Assuming his role on the committee and in the Dental School will be Dr. Peter Polverini. Dr. Polverini was not in attendance at this meeting; Dr. Gary Anderson attended in his place.
III. MERC 2000 Distribution Summary and Merc 2001 Application Process:
Diane Rydrych discussed the MERC 2000 distribution. Grants were mailed to the sponsoring institutions on September 1, 2000. Sponsoring institutions have 60 days to distribute the money to training sites.
MERC 2001 applications were mailed to sponsoring institutions on August 8th, 2000, and are due by October 31, 2000. The 2001 application process should be easier from a data collection perspective than previous MERC cycles; sponsoring institutions were given reports based on the 2000 application, allowing updates to be made on the report itself. This process should help cut down on the amount of time required to write out information on ongoing programs and sites. Additionally, cost data will not be required for the 2001 application with the exception of programs training provider types which have been included in the MERC distribution for less than three years. The only program this will effect will be the chiropractic program in 2001. Cost data will not be collected again for all institutions until the 2002 application.
For the 2001 distribution, Scott Leitz estimated that there will be an approximate total of $18+ million in grant funds. This will be comprised of $5 million from the general fund and $8.3 million from tobacco installments. The Department of Health assumes that there will be a federal match of $5 million on the general fund dollars.
On August 22, 2000, DHS received approval of the PMAP waiver. Rates will beginning being carved out on the first of the month one full month after the waiver was approved (which would be October 1, 2000). Scott Leitz estimated that $4.2 million will be distributed in 2000 and $18 million in 2001.
Funds will be distributed twice per year. Target dates for distribution will be in January and July. Since this is a new process in 2000, the target distribution of January 2001 may be a bit unrealistic. January will continue to be the goal; however, the Department asked that people be patient in this first distribution, as it will likely occur after January.
V. Establishment of PMAP Distribution Advisory Panel:
Scott Leitz reopened the discussion from the June Advisory Committee meeting regarding the formation of a separate committee to discuss PMAP. The group will consist of two out-of-state representatives from Washington DC and Texas, with the remaining six to seven members representing providers or foundations within Minnesota. The first meeting will be held on October 13, 2000, from 1 - 4 p.m. at the Veterans Service Building. It is estimated that the group will have two to three meetings with the second meeting being opened up for discussions or testimony from outside parties. The Advisory Panel is expected to wrap up discussions in November 2000 with a recommendation to the Commissioner of Health.
Scott Leitz discussed the plan to establish two distinct committees: the Medical Education Committee and the Medical Research Committee. The Medical Education Committee will consist of the same members. The Medical Research Committee will be formed with approximately 12 members. Mr. Leitz stated that the Medical Research Committee will not address funding in the first year, but rather would focus on defining the state's role around medical education. One member expressed concern over establishing a separate medical research committee, noting that medical education and medical research go hand-in-hand in the practice of medicine at teaching institutions. Chair Louis Ling stated that separating the two provides a better opportunity to advocate for increased funding. A committee member asked that the Minnesota Department of Health carefully watch that the divergent interests do not work at cross purposes.VII. Workforce Subcommittee Activities and Recommendations:
Dr. Crouse gave a brief history of the activities of the workforce subcommittee thus far and presented the group's preliminary recommendations. The committee has met three times, discussing other states' efforts to influence workforce composition and distribution through Medicaid carveouts or other methods, existing data collection tools in use in Minnesota and in other states, and possible strategies for identifying the highest priority workforce goals. The group concluded that existing data is insufficient for identifying the full nature and scope of the workforce problem, which extends beyond MERC provider types to include much of the healthcare workforce. They recommended that MERC support new data collection in the form of a set of trainee exit surveys to be administered to all trainees in the months prior to completion of training/residency and a statewide demand assessment (possibly an expansion of the current MCRH demand survey). The group also recommended that any eventual strategy enacted by MERC to address workforce concerns not be implemented through a change to the current distribution formula, but rather that MERC explore alternative mechanisms such as a new workforce grant pool or a set-aside of dedicated workforce funds.
Advisory Committee members noted that several groups in Minnesota are currently working on healthcare worker shortages, and that the University of Minnesota Academic Health Center's current legislative proposal includes not only new funding for program expansions to meet workforce needs but also a data collection component. Members felt that it is important for the workforce committee to work with these groups on any new data collection proposals to avoid duplication of effort or working towards cross purposes. Several Advisory Committee members felt that the workforce committee should look not only at strategies for quantifying the need for new bodies but also at other factors that influence demand for services, including changing the definition of how work is done, exploring new models of care delivery, discussing changes to scope of practice, and examining how population/demographic and health trends will influence long-term demand not just for physicians but for all provider types.
As next steps, the Advisory Committee recommended that the workforce committee continue looking at new data collection tools and have a draft exit survey available for comments at the next Advisory Committee meeting. They also recommended that the workforce committee should start exploring some of the system issues described above. The Committee also offered some recommendations related to gathering additional information about national salaries and openings by specialty and exploring the use of an interagency agreement to allow MERC to access data from physician and other provider licensure boards.VIII. Re-Estimating the Clinical Education Funding Gap:
Diane Rydrych presented the preliminary results of a study MDH is conducting on the gap between costs and offsetting revenues for clinical education programs in Minnesota. Several years ago, MDH staff had used cost and revenue data from a group of teaching hospital CFO's to estimate this gap for FY1993, but felt that given inconsistency in data collection methodologies, lack of data on direct costs for some provider types, and the need to use an estimate from a national consulting firm as a proxy for indirect costs, the resulting estimate of a $36 million funding gap was unreliable. In an attempt to improve on the estimate, MDH staff used data collected through MERC applications in 2000, supplemented with additional or revised data from the University of Minnesota, the Mayo Foundation, the Minnesota Department of Human Services, and other sources to calculate a revised figure.
The analysis showed a funding gap for all MERC-eligible programs for FY1998 of approximately $175 million. Ms. Rydrych noted that the results should be taken as a rough estimate only, as closer examination of the underlying data has revealed some inconsistencies in reporting methodologies for both costs and revenues that could have affected the resulting estimate. In addition, there are still several gaps in the data, especially in the areas of cost savings associated with the lower salaries paid to residents and resident-generated patient care revenues. Ms. Rydrych highlighted several areas that require further data cleaning or revision, and she suggested time be spent on these activities before releasing these results.
Advisory Committee members made several comments regarding possible sources of bias in the estimate, including the exclusion of non-Minnesota FTE's in total FTE counts and of Medicare DME/IME revenue for these trainees, possible missing revenue data, and the exclusion of programs that have not applied for MERC grants. Additionally, the committee recommended that more work be done to hone estimates of net benefits from trainees, clean up estimates of indirect costs, and revise language to include more information about the timing of BBA/BBRA provisions and how they are or are not reflected in this estimate and to clarify that the gap reflects costs/revenues for all MERC provider types, not just physicians.
When asked what this estimate should be used for, the Advisory Committee suggested that it could be a valuable tool for improving the quality of submitted MERC data; MERC staff should use this opportunity to explore changes to instructions that would make cost estimates more consistent, and they should consider making examples of all programs' cost estimates available to applicants as examples of methodology and cost ranges. Ultimately, the committee felt that the results, once refined, should be made available to the legislature and to the Governor's Health Policy Council, and possibly also expanded for publication.
Dates were established for Advisory Committee Meetings for the year 2001. At this time, meetings will be held from 1 - 4 p.m. at the Veteran's Building in St. Paul on the following dates:
Friday, March 30, 2001
Friday, June 22, 2001
Friday, October 5, 2001
Friday, December 7, 2001
The next MERC Advisory Committee Meeting will be held on Friday, December 8, from 1 - 4 p.m. in Metro Square Room LL56. Metro Square is located at 121 East 7th Place in downtown St. Paul.