1. Briefing on the NECO Clinical System NECO and NEEI Managed Programs September 24, 2008 MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERS Charles F. Mullen, OD

2. NECO Clinical Teaching System NECO/NEEI total pt visits AY08 = 133,000 NEEI patient visits AY08 = 82,000 Health Center patient visits AY08 = 55,000 Note 1: Data derived from student logs, error est. 5-10% Note 2: NEEI pts and health center pts are part of the 133,000 Clinical System comprised of 107 programs = NECO Affiliates (64) + NEEI Affiliates (43)

3. Flagships o New England Eye Commonwealth o New England Eye Roslindale Community Collaborations o Pediatrics, Geriatrics, Low Vision, Homeless, Individuals with disabilities Health Centers, Hospitals & Local VAs Contract management – NEEI managers Professional staffing – NEEI managers NEEI Manages Fee-based and contracts

4. 2 Flagship practices - NEEC & NEER 2 Peds - Framingham & Renaissance 7 Pediatric Sites (contracts) 5 Homeless Programs (fee based) 10 Low Vision/Geriatrics (fee based) 12 Health Centers (contracts) 3 Hospitals – BMC, Tufts, Children’s 2 VA sites (contracts) 43 NEEI Affiliates Fee-based and contracts

5. 20 VA Programs 18 Group Practices 9 Referral Centers 6 Federal Non-VA 6 Specialty Practices 3 Canadian Affiliates 2 Other international 64 NECO Affiliates Teaching programs

6. Student Placements 480 +/- Students Placements Annually Fourth year – all year round, US & globally o 4 Full time rotations Third year clinic – 1 day per week locally o Semesters + summer sessions Second year clerkship – 1/2 day per week locally o Semester placements First year screenings & observations – 1/2 day per week locally o Semester placements

7. 29 Residencies 22 VA Based 2 Pediatrics 2 Cornea and Contact Lens 2 Health Center Based 1 Ophthalmology Practice

8. Residencies NECO has the largest post-graduate residency program in the country Residents see a combined total of X number of patient visits

9. FY09 NEEI Budget

10. 3.6M = Educational Service Revenue 1.5M = Patient Care Revenue 0.8M = Health Center Contracts 0.4M = Other Contract Revenue 0.2M = Grants/Contributions/Other _______________________________ Total = 6.5M

11. NEEI Network Gross Educational Cost Analysis TBDTBD

12. NEEI Network Gross Educational Cost/pt visit (does not include revenues) PROGRAM GROSS COST Entire NEEI Network $78 NEEI Owned Programs $124 3 rd Year NEEI Owned $262 Health centers $34 NECO Affiliated programs TBD

13. Why is Cost of Education lower at Community Health Centers? Contracts at CHCs allow us to cover between 70-100% of our full costs No overhead at CHCs, only personnel o Exception NEER which we own and operate More patients reduce educational costs Health centers own the practice – responsible for billing, equipment, etc o Exceptions – contributions to start up or improvements for education on individual basis

14. Example: Clinical Education at Health Centers (CHCs) Residencies: Community Health Optometry = 2 More than 350 Annual Student Placements 4 th = 139 full-time rotation (36% pt from CHCs) Range pt per quarter = 200-250 (40 hr/wk) 3 rd = 108 @ 1 day/wk (60% pt from CHCs) Ave number pt seen per semester = 40 (1 day/wk) 2 nd = 78 four hr clerkships slots 1 st = 50 four hr observation slots

15. Benefits of Collaboration Comprehensive/coordinated care on site High quality of patient care Prestige of academic affiliation o Workforce development Joint grant applications Shared costs and financial benefits Added “value” (best practices, staff quality) Reduced cost of education Public health education/confront disparities

16. Professional Staffing Total FTE in Clinical System = 23.6 NEEI Professional Staff Faculty = 18.4 NECO Tenure Track Faculty = 4.4 Part-time/Other = 0.8 NEEI Professional Staff are a category of faculty with primary job duties of patient care and clinical teaching.

17. Challenges Analysis should be conducted to define the full cost of education of NECO affiliates Resource allocation for the clinical system needs further study Impact of increased student enrollment on clinical system needs further study