Cheryl Haynes, Residency Manager Darcy Hitz, Residency Coordinator Bean Counting 101: Add “Accountant” to the Coordinators’ Job Description Cheryl Haynes, Residency Manager Duke/Southern Regional AHEC Family Medicine Residency Fayetteville, NC Darcy Hitz, Residency Coordinator Moses Cone Family Medicine Residency Greensboro, NC With special thanks to Annette Sheets Coordinator, Graduate Medical Education, Williamsport Family Medicine Residency

Objectives Understand the new ACGME requirements for Resident patient encounters Utilize tools for documenting and tracking the requisite encounters Assist the Program Director in completing the Residency Performance Index.

Where do we start?? The White Rabbit put on his spectacles. “Where shall I begin, please your Majesty?” he asked. “Begin at the beginning”, the King said, very gravely, “and go on till you come to the end; then stop.” – Lewis Carroll As coordinators, we often feel like Alice trying to follow White Rabbits and being mindful of smiling Chesshire cats! In meeting our objectives today, we hope to restore some of the wonder to your land. And so we will begin at the beginning….the new accreditation standards.

IV.A.6. Curriculum Organization and Resident Experiences ACGME Program Requirements for Graduate Medical Education in Family Medicine IV.A.6. Curriculum Organization and Resident Experiences

Required Patient Encounters “BEANS”

1650 in-person patient visits in the Family Medicine Residency Center 165 age 60 or over 165 younger than 10 600 hours/six months and 750 patient encounters with hospitalized patients 100 hours/one month or 15 ICU patient encounters Disclaimer: This is not the complete list of requirements. For the purpose of this presentation, we are using just those requirements that our programs have to count.

200 hours/2 months or 250 adult ED patient encounters 100 hours/1 month or 125 patient encounters for care of older patient  100 hours/1 month or 125 patient encounters for care of women

200 hours/2 months and 250 patient encounters for ill children 75 inpatient 75 emergency dept 200 hours/2 months or 250 patient encounters children and adolescents in ambulatory setting 40 newborn patients, including well and ill

AND/OR Your curriculum determines what you need to count. 600 hours/six months and 750 patient encounters with hospitalized patients 100 hours/one month or 15 ICU pt encounters Make a point of the and’s and or’s. I.e., in my program, an ICU rotation is an elective, so we have to document 15 ICU pt encounters. So, first we have to know what we have to count…Again, for each individual program, review your curriculum and check to see what parts of your curriculum cover the “or”s and determine what you have to count as a starting point.

From the ACGME website, Family Medicine revised FAQ’s What is the implication of the use of "and" versus "or" in relation to hours/months of certain patient exposure/experiences? [Program Requirements: IV.A.6.b)-j)]

ACGME’s answer: The nature of these requirements is not to confine, but to allow for flexibility. Measurement of specific patient encounters is required or allowed to meet several requirements, providing programs the flexibility to design curricular experiences without time restrictions, yet ensuring adequate experience for each resident. If a requirement uses “and,” the program must document both hours and patient numbers; if a requirement uses “or,” the program may use either measurement. Just as we learned from the “should”s and “must”s of Duty Hours rules, the ACGME is again keeping us on our toes with “and”s and “or”s!

HOW DO WE DO IT? Rely on EHR? Rely on popular online programs that are neither new nor innovative and make you need a pub? Rely on the Residents? How do we know if we are counting correctly? Then we have to figure out how to do it.

From the horse’s mouth… Per Peter Carek, MD, MS, Chair, Review Committee for Family Medicine (RC-FM): “The RC-FM would just need to know that the program had a system to collect and enter the data (as you said, be able to show the work if asked). The mechanics of the system are left to the program."