Georgia preceptor tax incentive program (ga-ptip): Providing value to our volunteer community based faculty

Presented by: Erin Mundy, MPA Director of Community Based Training Programs Georgia Statewide AHEC Network Program Office Assistant Professor, Department of Family Medicine Medical College of Georgia at Augusta University

What is ptip (Preceptor tax incentive Program)? Governor Nathan Deal signed into law April 15, 2014 legislation that creates tax deductions of up to $10,000 for uncompensated community based faculty physicians who provide training to medical, osteopathic, physician assistant and nurse practitioner students matriculating at Georgia public and private educational institutions.

What Does PTIP Do? It provides an economic incentive to Georgia providers to participate in the training of future health care professionals It is limited to only those providers who receive no compensation from any source to train medical, osteopathic, PA, or APRN students The incentive is only available for those providers who train students from Georgia educational program- public or private

WHY DO YOU CARE? It can aid with recruitment of new providers It can add financial benefits to your providers It can expand coverage in your facility It connects your providers to academic institutions for faculty appointments and benefits

History of PTIP

History of pTIP 2012 Primary Care Summit recommendation First of its kind in the United States Began as HB 922 sponsored by Rep. Ben Harbin; passed as SB 391 on Sen. Don Balfour’s Tri-Care Bill Department of Revenue language negotiated for Tax Manuals for 2014

Rational and Background for ptip Physicians, advanced practice registered nurses (APRN) and physician assistants (PA) are considered to be the core disciplines in primary care. Georgia faces a critical shortage of health care professionals, particularly those in primary care. To combat the shortage, Georgia has invested significant resources in expanding medical school class sizes, and the number and sizes of programs in advanced practice registered nursing and physician assistant education. As each discipline has expanded its class sizes, the demand for community based faculty preceptors has grown exponentially. Most community based faculty preceptors in Georgia are not compensated for their time teaching but do so as part of their personal commitment to the health care system.

Challenge address: Off-shore and out-of-state medical schools are using Georgia CBF and paying them +/-$1500 per rotation.  Rather than enter into a bidding war with these other players, a tax incentive could provide a powerful incentive to Georgia CBF to ONLY take Georgia Medical, Physician Assistant, and Advanced practice registered nursing students. If Georgia MD/DO, PA and NP programs were forced to pay $1500 / rotation, then the expected cost would be approximately $7,219,500 (4,813 rotations x $1500 each).  Since the majority of these rotations occur at a program based within the University System of Georgia, the state would be asked to help fund approximately 1/3 to 1/2 of these funds; without additional funding, students matriculating in these programs would be asked to pay additional fees.   Additionally, given the deep pockets of the off-shore and out of state programs, the “price” for rotation could and most likely would be pushed higher as the “bidding war” begins for the community- based clinical training sites and faculty.

Solution – ptip In order for Georgia to provide community based education demanded by the three critical health disciplines (physician, APRN and PA) they must be able to compete with the out-of-state and off-shore programs who are willing to pay Georgia community based faculty to take their students. Georgia can either pay the preceptors or create a valuable benefit to preceptors that would sway them to ONLY take Georgia medical, APRN and PA students. Solution – GA PTIP - Georgia physicians who provide clinical training to health professions students for a minimum of three (to a maximum of 10) rotations, and who are not compensated through any other source, can claim a tax deduction of $1,000 for every 160 hours of training provided. Students must be enrolled in one of the state’s public or private medical/osteopathic, physician assistant or nurse practitioner programs.

Physician eligibility Must be a licensed physician in GA Cannot receive direct compensation for teaching medical, osteopathic, NP or PA students Deduction only available for rotations supporting Georgia medical, osteopathic, NP or PA programs Must complete a minimum of 3 rotations to be eligible; deductions are provided retroactively once eligibility is established A maximum of 10 rotations may be claimed for deductions each calendar year

Physician eligibility The only rotations available to receive the deductions are: Family Medicine General Internal Medicine (inpatient and ambulatory) General Pediatrics OB/GYN Emergency Medicine General Surgery

Eligible programs: medical / osteopathic

Eligible programs: physician assistant Augusta University PA Program Emory University PA Program Mercer University PA Program PCOM-GA Campus PA Program South University PA Program

Eligible programs: Nurse practitioner Georgia Southern University Georgia State University Kennesaw State University Mercer University University of North Georgia Valdosta State University Albany State University Armstrong Atlantic University Augusta University Brenau University Emory University Georgia College and State University

Ga ptip: mechanics

Ga-ptip website: www.augusta.edu/ahec/ptip

Ptip provider portal One time online registration through a secured website portal Will not need to renew annually but can edit if key information changes Registration Portal: www.augusta.edu/ahec/ptip

Ptip Program portal Programs submit eligible completed rotations directly into a secure database three times per year: Rotations completed between Jan – May are due June 1 Rotations completed between June – Aug are due September 1 Rotations completed between Sept – Dec are due December 15

Ga Statewide ahec program office The Georgia Statewide AHEC Program Office at Augusta University administers the PTIP Program and certifies rotations Only the Statewide AHEC Program Office can certify eligible rotations Maintains PTIP website and portals Summarizes all data and issues tax deduction certification letters by January 31 of each year for the last full calendar year Provides a report to the Legislature each year

FREQUENTLY ASKED QUESTIONS

Can the educational programs register the preceptor Can the educational programs register the preceptor? Ideally, they should not. Programs can direct preceptors to the website to provide their information directly. www.augusta.edu/ahec/ptip

Do specialty rotations count toward deductions (e. g Do specialty rotations count toward deductions (e.g. NICU/nursery, orthopedics, etc.)? Only if the experiences are part of a core rotation (e.g. pediatrics, general surgery, etc.).

If a student only needs 80 hours, will that count as a rotation? No, however those 80 hours would be recorded and if you precepted another student for 80 hours they would be added together to give you one rotation.

Would a provider receive full credit for precepting a student if the student rotates with more than one provider in that clinic? The deduction can be rotated among partners, apportioned among them, or claimed by one. Whatever is decided, the academic program must report it as such.

Can preceptors earn credits from teaching students from multiple programs? Yes, preceptors choose which educational programs they wish to work with and are not limited to working with just one. They can also precept students from different disciplines (e.g. medicine and APRN students). These choices are entirely up to the preceptor and the Georgia based educational programs who credential him/her.

Why are we providing a tax incentive program for a group of professionals who have such healthy incomes? The tax incentive program is a strategy to support the educational needs of the medical, osteopathic, advanced practice nursing and physician assistant academic programs, who rely on volunteer community based faculty preceptors to conduct vital parts of their educational curriculum. So while the tax incentive program is certainly of personal value to the preceptor, it is a collateral benefit but not the target of the program.

How does this program help with alleviating the state’s primary care workforce shortages? To create the workforce needed, we must first produce graduates from educational programs in the state. If we cannot meet the clinical training needs required by these programs, then we cannot produce graduates. While this program does not specifically create more primary care providers, it does insure that students in the educational pipelines can complete their general training and then potentially pursue primary care practice.

Will you provide an overview letter for physicians or can the education institutions send the information received today for preceptors? You are welcome to communicate this information to your preceptor directly. Brochures have been developed that you can download and send from your offices is so desired.

PTIP Data to date

2016 ptip data 719 preceptors have registered and 305 qualified to receive deductions and have received letters 223 additional preceptors were eligible to receive deductions but did not register with the program. There were 26 of 26 eligible academic programs who provided rotation and training hour reports. A total of $1,998,000 in deductions have been certified by the Statewide AHEC for 2016 state income tax filings as of this date.

What rotations led to deductions? 66% of the deductions were earned and awarded for MD/DO student support. APRN /Nurse practitioner students accounted for 15%. PA students accounted for 19%.

TABLE A: FY16 – PTIP Training Hours Reported by School/Program   UNIVERSITY MED/DO NP PA TOTAL Hours Albany State University 1,919 Armstrong Atlantic University 3,679 Augusta University 222,436 9,093 31,880 263,409 Brenau University 7,088 Clayton State University 2,635 Columbus State University 6,053 Emory University 39,549 9,826 28,978 78,353 Georgia College and State University 7,884 Georgia Southern University 5,053 Georgia Southwestern State University 2,453 Georgia State University 23,530 Kennesaw State University 4,087 Mercer University 58,588 10,380 51,290 120,258 Morehouse University 8,279 Philadelphia College of Osteopathic Medicine 207,160 2,920 210,080 South University 13,125 38,400 51,525 University of North Georgia 6,092 Valdosta State University 6,229 Total Hours Reported 536,012 119,126 153,468 808,606 Total Programs Reporting Data 5 16 26 Total Programs Eligible to Report Data

Where were the community based faculty who received deductions earned?

2016 counties of ptip recipients

2017 counties of ptip recipients

Georgia Physician Tax Incentive Program, Summary Data, 2014-2016   2014 2015 2016 30 MONTH TOTAL # of hours reported 438,612 895,552 808,606 2,142,770 # of possible rotations 2,741 5,597 2,377 10,715 # of registered preceptors 563* 582 719 N/A # of preceptors awarded deductions 326* 243 305 874 # of preceptors eligible but not registered 490 404 223 Amount of deductions awarded $883,000 $1,513,000 $1,998,000 $4,394,000 Actual value of deductions (6%) $52,980 $90,780 $119,880 263,640 # of eligible programs reporting 18/23 23/25 26/26

New/pending Legislation

Hb 301 summarized HB 301 converts the existing Tax Deduction to a Tax Credit Expands eligibility to include PA and APRN preceptors Removes the limitation on types of medical rotations Includes an incentive plan to encourage more rotations be supported Has passed House and is now in Senate Finance Committee Needs to pass Senate in 2018 Legislative Session

boundaries recommended Tax credit caps will have to be identified so there is no incentive to take more students than quality education standards can sustain (e.g. maximum of $10,000 credit annually). Tax credit would be non-transferable. Unused Tax credit would not carry over to another tax year. There should not be a “cash-out” option for unused credit.

What can you do? Make sure your preceptors are registered Make sure academic institutions/programs are submitting all possible rotations with accurate information in the appropriate formats Communicate upcoming changes to your preceptors and request their support and assistance with legislators Promote the need for tangible recognition of CBF to every audience you have- particularly legislative Have your professional organizations join us in advocating for HB 301

Special thanks: To the Medical College of Georgia @ Augusta University for underwriting the administrative costs of this program, for our valued community based physicians who are supporting our primary care education pipeline.

Contact information: Erin Mundy, MPA emundy@augusta.edu 678-232-3759 Cindy Peloquin cpeloqui@augusta.edu 706-721-8558