Expansion Grants Program Graduate Medical Education Expansion Grants Program Good afternoon. Thank you all for attending this Graduate Medical Expansion Grant Program Forum. We hope to provide you with the information you need to make a decision regarding applying for a grant under this program. This information will be presented in several sections: Suzanne Pickens, MBA Senior Program Director Academic Quality and Workforce Division

Presentation Topics Graduate medical education, or GME, in Texas and the state funding appropriated to support its expansion Planning and Partnership Grants Program GME Expansion Program awards in Fiscal Years (FY) 2014 and 2015 GME Expansion Grants Program for FY16-17 Questions First will be an overview of certain statistics relating to medical and graduate medical education, or GME, in Texas and the state funding appropriated to support GME expansion. Next, will follow a brief review of the Planning and Partnership Grants Program. Then, a review of GME Expansion Program awards in Fiscal Years 14 and 15. And, finally, the GME Expansion Program for FY16-17, including submission deadlines, program eligibility, selection criteria, and other program requirements. We have time for a few questions very brief questions at the end of each section, but the main question and answer period will come at the end of the presentation. Some of you may have questions that are very specific to you own situation. Those questions may be better addressed one-on-one during the break, or at the end of the forum, and I will be available to do that.

What is Graduate Medical Education? Final formal education required to become a licensed physician and begin medical practice GME programs range from 3 to 7 years in length, depending on specialty Residency programs are primarily located in hospitals and residents rotate in clinic and community settings Often residents will practice medicine near the community in which they completed residency training Obtaining a residency position is done through a national matching process As most of you know, graduate medical education is … the final stage of formal education that a physician must complete: prior to receiving a Texas medical license, entering independent practice, and obtaining board certification in a medical specialty area. Residency training is a 3-7 yr commitment of education and training in a nationally accredited program, typically located in hospital settings. At this point in time, residency programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME) OR the American Osteopathic Association (AOA), depending on whether the residency program accepts MD- and/or DO-trained physicians. These 2 accrediting bodies are in process of merging. Often residents will practice medicine near the community in which they completed residency training

Graduate Medical Education Expansion Why is support for GME important?

Graduates and GME 1st Year Positions This chart presents data on medical school graduates & available 1st-yr residency positions. The data for FY15 and going forward are estimates. CB will not complete certification of 2015 data until late NOV. The important aspect of this chart is the projected, widening gap between the number of medical school graduates and available 1st-yr residency positions in the state. Texas medical schools increased their enrollments by more than 30 % over the past decade. But, the number of entry-level GME training positions has not kept pace, and, as a result, some Texas medical school graduates have to leave the state for their residency training. These physicians may not return to Texas to practice. As shown by the green line, the projected number of medical school graduates for 2015 is just over 1700. Over the next 7 yrs, there is an estimated net increase of 500 graduates/yr. The estimated increase takes into account 2 new medical schools that will begin accepting students in fall 2016 and other new medical schools and expansions at existing schools planned for 2017 and 2018. The red line shows available 1st-yr residency positions. Again, data shown for 2015 and later years are estimates, not certified totals. The purple line illustrates the state’s goal of achieving 1.1 1st-yr GME positions for every medical school graduate.

State Funding Appropriation Graduate Medical Education Expansion Program State Funding Appropriation FY 2014 - FY2015 FY 2016 – FY 2017 Planning Grants $ 1,875,000 $ 3,500,000 Unfilled Position Grants* New and Expanded Program Grants* $ 7,375,000 $ 9,750,000 $ 7,200,000 Resident Physician Expansion Program $ 5,000,000 $0 GME Expansion Consolidated $32,550,000 Total GME Expansion Appropriation $14,250,000 $53,000,000 *These programs were jointly funded from a single appropriation in FY 2014-2015. In 2013, the 83rd Texas Legislature created several GME grant programs intended to encourage expansion of graduate medical education across the state and appropriated $14.25 million to initiate 4 targeted grant programs. The 84th Texas Legislature consolidated the programs and increased the appropriation for FY16-17 to $53 million. This funding will allow the positions that were created in FY14-15 to continue as well as allow for the development of additional new residency positions. More detail on the FY16-17 program will come later in the presentation.

Planning and Partnership Grants Program The next section will present information on Planning Grant Awards in FY 14-15 and the changes to the program for FY16-17. This section will be brief. The primary focus of today’s presentation will be grants that more directly support expansion of existing and creation of new 1st-yr residency programs.

Planning Grants The Program in FY14-FY15: Funding support to investigate the feasibility of becoming a teaching hospital To ultimately Increase the number of hospitals training residents Increase availability of first-year residency positions Competitive, one-time, 2-year awards $150,000/award Eligibility in FY14-15 was restricted to hospitals not currently engaged in residency training Awards provided these hospitals funding to investigate the feasibility of becoming a teaching hospital The goal was to increase the number of hospitals training residents and, ultimately, increase the # of first-year residency positions The awards were competitive and provided $150,000 over two years.

Planning Grants Award Amount FY14 – FY15: $1,350,000 9 Grant awards 12 Possible new GME programs 8 new programs have obtained national accreditation 5 of these began operation July 2015 The total of $1,350,000 to 9 grantees has led, to date, to accreditation of 8 new programs. 5 of these began operation July 2015 accepting a total of 30 first-year residents. Accredited: 3-FM, 2-IM, OB/G, Surgery, TI July 2015: 2-FM, IM, OB/G, Surgery

Here you can see the geographic distribution of the awards.

Planning and Partnership Grants The Program in FY16-FY17: Continued focus on first-year residency programs Funding to support the planning and development of programs with first-year residency positions Changes for FY16-FY17: Partnerships encouraged between eligible applicants Eligibility expanded: hospitals; medical schools; and community-based, ambulatory patient care centers One-time, competitive award increased to $250,000 The Planning and Partnership Grant program was continued and expanded by the 84th Texas Legislature. The addition of Partnership Grants allows more entities to participate in the planning and development of new residency programs. Grants may now be awarded to hospitals, medical schools, federally qualified health centers, and community-based ambulatory health centers in the state interested in establishing a new residency program. Award amount increased to $250,000

Planning and Partnership Grants The Program in FY16-FY17: $3.5 million available for awards Funding allows 14 awards of $250,000 each 2-year awards Application solicitation planned for March 2016 For FY16-17: $3.5 million is available for one-time grants of $250,000 each, to be awarded on a competitive basis. The CB plans to release the Planning and Partnership Grant Program Request For Applications in March 2016 If there are no QUESTIONS on Planning & Partnership Grants, we will continue on to GME Expansion Grant Awards

GME Expansion Grant Awards FY 2014 and FY 2015

Residency Position Awards: FY14-FY15 Overview Total New First-Year Positions Funded:   100   First-Year Positions Funded by Program by Year  FY14 FY15 FY16 (estimated) Total Unfilled Positions 25 - New/Expanded Programs 50 Resident Physician Expansion 13 12 63 Total Positions Funded by Program by Year 75 55 20 56 76 125 206 Total Funding Awarded $4,875,000 $2,975,000 $4,940,000 $12,790,000 This slide is a bit crowded, But the most important information is in the blue box at the top: 100 new 1st-yr positions were created in the FY14-15 funding cycle for GME Expansion position awards. 25 through the UFP, 50 through Grants for NEP, & 25 through RPE program. In addition to the creation of new 1st-year positions, these awards also supported new positions at levels higher than 1st-yr. For example, UFP awards spanned a 2 yr period, so when the 1st-yr residents move to the PGY 2 level in the 2nd yr of the grant, those positions were also supported by grant funds. 29 GME programs received a total of 206 residency position awards for 1st-yr & higher level positions. Total award amount was $12.8 million.

Residency Position Awards: FY14-FY15 Overview Positions by Specialty   Unfilled Positions New/ Expanded Programs Resident Physician Expansion Total Anesthesiology 6 - Emergency Medicine 2 Family Medicine 10 22 Family Medicine RRT Internal Medicine 39 25 103 Neurology Obstetrics/ Gynecology 3 4 Pediatrics Plastic Surgery Integrated 9 Psychiatry Psychiatry/Child Psychiatry 15 Surgery 75 55 76 206 12 medical specialties were included in the 206 positions awarded. 75% of the positions were awarded to medical specialties in primary care and psychiatry. Awards were also made to programs in: Anesthesiology Emergency Medicine Neurology Plastic Surgery Integrated, and Surgery

Unfilled Position Grants Increase the number of filled first-year residency positions Fill accreditor-approved but unfilled positions in existing programs Support for direct resident costs $65,000/newly created residency position/year Total positions awarded: 75 Total award amount: $4,875,000 UFP grants provided support for GME programs to fill accreditor-approved positions that were unfilled because programs could not financially support them. In FY14-15, 9 GME programs received awards totaling $4.875 million over a 2-yr period. Individual positions were funded at $65,000/yr Awards covered 75 positions filled in July 2014 and 2015.

This map illustrates the geographic distribution of the awarded programs.

Grants for New & Expanded Programs Increase the number of first-year residency positions Expansion of existing accredited programs, or Establishment of new accredited programs Support for direct resident costs $65,000/newly created residency position Total positions awarded: 55 Total award amount: $2,975,000 Grants for NEP provided support to existing GME programs to expand the # of approved first-year residency positions, OR To sponsoring institutions to establish a new GME program with first-year residency positions. Funding supported direct resident position costs, including resident stipends and benefits. Awards were $65,000 per qualified residency position per year, with the exception of Planning Grant-supported new positions, which were funded at $35,000 per year. Awards totaled $2.975 million and funded 55 new positions in 11 GME programs.

This map shows the geographic distribution of the awarded programs.

Resident Physician Expansion Program Creation of new GME positions through community collaboration, innovative funding Support for direct resident costs Competitive awards: $65,000/residency position/year 2 year competitive award Total positions awarded: 76 Total award amount: $4,940,000 Resident Physician Expansion Program awards were intended to encourage the creation of new GME positions through community collaboration and innovative funding. Grants were awarded on a competitive basis 76 positions were funded across 9 GME programs SB 18 abolished the RPE program but also made provision for the FY14-FY15 grantees to be transitioned into the consolidated GME Expansion Grant Program in FY16-17, if awardee continues to meet original the grant program criteria (Edinberg, El Paso, Galveston, Houston, Lubbock, San Antonio, & Victoria)

GME Expansion Grant Program FY 2016 and FY 2017 Now that we’ve looked at the GME Expansion Grants Program history, we’ll turn to the current embodiment of the program.

GME Expansion Grants Program Senate Bill 18 Consolidates individual grant programs into one overall program to support an increase in the number of first-Year residency positions in the state Maintains support for positions funded in FY14-FY15, if original grant criteria are met Allows newly created and newly expanded programs to receive funding Allows funding of positions for the duration of the residency program The 84th Texas Legislature, through Senate Bill 18, continued and consolidated the GME Expansion Grants Program. Support for positions created in FY14-15 is maintained And support for newly created and newly expanded programs is included. The statute allows funding of positions for the duration of the residency program.

GME Expansion Grants Program General Revenue Appropriation for FY16-FY17 $49.5 million for the GME Expansion program Maintain support for positions funded in FY14-FY15 at $65,000/position/year Funding for positions newly filled in FY16-FY17 at $75,000/position/year The legislature appropriated $49.5 million for the GME Expansion program $65,000/position/yr will maintain support for positions initiated in FY14-15 until the resident completes the program. Newly filled positions in FY16-FY17 will be funded at $75,000/position/year There is a slide coming up just a bit later that will provide more detail on position funding.

GME Expansion Grants Program Request for Applications (RFA) Released: October 21, 2015 Applications received after this date will not be considered for funding. Point of Contact Suzanne Pickens Senior Program Director Texas Higher Education Coordinating Board Email: GME-Expansion@THECB.state.tx.us Application Deadline: November 19, 2015 The Request for Applications, or RFA, was released late last month Application Deadline: November 19, 2015. This is a Thursday. I am the point of contact for information about the RFA. I have business cards available with my contact information for anyone who would like one.

GME Expansion Grants Program To access RFA, submission instructions, and grant application forms: GME Expansion Web Site: www.thecb.state.tx.us/GMEXP Submit completed applications to: GME-Expansion@THECB.state.tx.us This slide shows the web site where the RFA, submission instructions, and grant application forms are available. Applications must be submitted electronically by email to the address shown.

GME Expansion Grants Program RFA seeks applicants intending to: Maintain new first-year residency positions created during FY14 and FY15 under Unfilled Position Grants, Grants for New and Expanded Programs, and/or the Resident Physician Expansion Program; Increase and fill the number of accreditor-approved first-year residency positions in existing programs; and/or Establish new GME programs with accreditor-approved first-year residency positions First-Year Residency Position – A position filled by a physician who is entering into residency training for the first time. These positions are also referred to as entry level positions and do not require any prior years of GME training. The RFA targets applicants intending to: Maintain positions created under the program in FY14-15, Expand an existing residency program with 1st-yr positions, &/or Establish a new residency program with 1st-yr positions Grantees that received awards under UFP & Grants for NEP in FY14-15, must submit an application by NOV 19 of this year to receive funding for FY16-17. Grantees that received awards under the RPE Program, currently have funding through FY 16 To receive funding for FY 17, RPE grantees MUST submit an application by NOV 19.

GME Expansion Grants Program Grant Period April 1, 2016 through August 31, 2018 The grant period will be: April 1, 2016 through August 31, 2018 And will cover 2 complete GME academic yrs Funding must be expended by AUG 31, 2018 Awards support filled positions in 2 complete GME academic years. All award funding must be expended by August 31, 2018.

GME Expansion Grants Program RFA Section 4 – Eligible Programs and Applicants Eligible GME Program: An existing, new, or planned, nationally-accredited post-doctor of medicine (M.D.) or post-doctor of osteopathic medicine (D.O.), non-military residency program; Has, or will have, new first-year residency positions; and Intends to fill its new first-year residency positions no later than July 2017. The next two slides focus on grant program eligibility: An Eligible GME Program is: An existing, new, or planned, nationally-accredited post-doctor of medicine (M.D.) or post-doctor of osteopathic medicine (D.O.), non-military residency program; That has or plans new first-year residency positions; and Will fill the residency positions no later than July 2017.

GME Expansion Grants Program RFA Section 4: Eligible Programs and Applicants Eligible Applicant: An eligible GME program, as defined in the previous slide; or A sponsoring institution that has an eligible GME program; or A sponsoring institution that intends to create an eligible GME program An Eligible Applicant is: An eligible GME program, as defined in the previous slide; or A sponsoring institution that has an eligible GME program; or A sponsoring institution that intends to create an eligible GME program In this context, sponsoring institution is used in a broad sense. Some applicants may intend to apply for accreditation as an ACGME sponsoring institution AND we realize that AOA does not accredit sponsoring institutions in the way that ACGME does.

GME Expansion Grants Program Award Amounts Per Position $65,000/position/year Maintain support for positions funded in FY14-FY15 Applies to PGY 2 level and above positions $75,000/position/year Support for positions newly filled in FY16-FY17 Applies to PGY 1 positions created in FY14-FY15 and filled again in FY16-FY17 As mentioned earlier, Award Amounts Per Position are: $65,000/position/year: to Maintain support for positions funded in FY14-FY15 $75,000/position/year: to support positions newly filled in FY16-FY17 PGY refers to Post Graduate Year, a resident's current year of accredited graduate medical education. This designation may or may not correspond to the resident’s year in a particular program.

GME Expansion Grants Program Award Amounts Per Position Example GME Program: 7 Position Awards Received in FY14-FY15   Awarded Positions FY14-FY15 Positions to Include in Application FY16-FY17 GME Program Start Date >>> July 2015 July 2016 July 2017 Total PGY 1 7 14 PGY 2 PGY 3 21 35 Award / Position: $65,000 $75,000 This slide is to help clarify the position funding: It is an example of a GME program that was awarded funding for 7 residency positions in FY14-FY15, And how the program positions would qualify for funding in FY16-FY17. The 7 PGY 1 positions awarded in FY14-FY15 would qualify for $65,000/position at the PGY 2 level starting July 2016 and at the PGY 3 level starting in July 2017. These cells are shaded Green The PGY 1 positions filled in July 2016 and July 2017, and the PGY 2 positions filled in July 2017, all qualify for $75,000/position. These cells are shaded yellow

GME Expansion Grants Program RFA Section 7 – Grant Application Format Each application must include three completed forms and all required attachments, as described in RFA Section 7: Form 1 - Application Certification: 1 per application Form 2 - General Applicant Information: 1 per application Form 3 - GME Program Information: 1 for each eligible GME program for which funding is being requested. Each application must include three completed forms and all required attachments, as described in RFA Section 7: Form 1 - Application Certification: 1 per application is required Form 2 - General Applicant Information: 1 per application is required Form 3 – Information Specific to the GME Program : 1 for each eligible GME program for which funding is being requested.

GME Expansion Grants Program RFA Section 8 – Allowable Cost Categories Grant funds must be expended to support direct program costs in the following categories: Resident Compensation: Salaries/stipends and benefits for residents participating in the awarded program Professional Liability Insurance: For residents participating in the awarded program Other Direct Resident Costs, as justified in the application In FY14-15, the grant program expenditures were restricted to resident compensation and PLI. For FY16-17, SB 18 broadened allowable expenditures to allow other costs directly related to the education and training of the residents. This is not meant to include things such as travel or recruitment. But could include, for example, faculty compensation if directly attributable to residency education. Especially if a program expansion requires additional faculty to satisfy Residency Review Committee requirements. These costs should be clearly justified in the application.

GME Expansion Grants Program RFA Section 2.3: Criteria for Award Selection First funding priority: Maintain support for positions funded in FY14 and FY15 under Unfilled Position Grants, Grants for New and Expanded Programs, and the Resident Physician Expansion Program.   Second funding priority: Award funds of $12 million over the 2-year award period to new or existing GME programs that increase the number of first-year positions in residency programs in primary care specialties. Third funding priority: Award funds to new or existing GME programs that increase the number of first-year positions in residency programs in psychiatry. 3 Funding Priorities are the initial criteria for award selection. First funding priority: Maintain support for positions funded in FY14 and FY15 under Unfilled Position Grants, Grants for New and Expanded Programs, and the Resident Physician Expansion Program.  Second funding priority: Award funds of $12 million over the 2-year award period to new or existing GME programs that increase the number of first-year positions in residency programs in primary care specialties.   Third funding priority: Award funds to new or existing GME programs in psychiatry.

GME Expansion Grants Program Criteria for Award Selection, continued After the 3 funding priorities have been addressed, all other programs with first-year residency positions will be considered for funding. THECB may limit the number of grants awarded to individual applicants, depending on the number of qualified applications submitted. Award announcement target date: January 2016. After the 1st 3 funding priorities have been addressed, all other programs with first-year residency positions will be considered for funding. Depending on the number of qualified applications received, THECB may limit the number of Grants awarded to individual applicants. THECB expects to announce awards by January 2016.

GME Expansion Grants Program RFA Section 10.1: Verification of Filled Positions To qualify for distribution of awarded funds, Awarded Applicant must verify that the funded residency positions have been filled. Applicants will submit verification March – May in 2016 and 2017 for positions filled for the following July. Applicant shall forfeit the award for any unverified positions. BY statute, CB cannot disburse funding until it receives verification that the Awarded positions have been filled. Verification will be submitted after the American Osteopathic Association and National Residency Matching Program matches have completed. Any programs with positions not verified as filled will forfeit the awards.

Future Notifications from THECB Register for notifications from THECB related to GME issues through e-Updates at: www.thecb.state.tx.us. THE CB has put in place a new system for disseminating information to interested parties. We encourage you to register for notifications related to GME issues through e-Updates on the Coordinating Board’s website at www.thecb.state.tx.us.

Contact Information: Suzanne Pickens, MBA Senior Program Director Division of Academic Quality and Workforce GME-Expansion@THECB.state.tx.us, or Suzanne.Pickens@thecb.state.tx.us P.O. Box 12788 Austin, TX 78711 512-427-6240 This concludes my prepared remarks. Stacey and I will now be happy to take your questions. I realize that some of you may have questions very specific to your own situation, and I will be available during the break and at the end of the forum to meet with you one-on-one. You may also contact me later by phone or email to address your questions.