1. 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

2. 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.

3. 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.

4. 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

5. Required Patient Encounters
“BEANS”

6. 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.

7. 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

8. 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

9. 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.

10. 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)]

11. 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!

12. 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.

13. 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."