Draft New Title VII Legislation

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DraftNew Title VII Legislation

• Presented at STFM Meeting
• Seattle, Washington
• May 2, 1999

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New Title VII Legislation Health Professions
Education Partnerships Act of 1998

• Division of Medicine
• Bureau of Health Professions

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Overview of Title VII Changes in Title
VII Relevance to Grant Reviewers Peer Review
Process
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Title VII Purpose

• To assist a public or nonprofit private hospital,
  school of medicine or osteopathy, or nonprofit
  entity to plan, develop, operate or participate
  in an approved professional training program in
  family medicine

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Title VII Changes

• 1. 44 separate BHPr programs consolidated into 7
  programs
• 2. Funding priority in Academic Admin. Units
  program (Departments)
• -- collaborative project between departments
• of primary care
• 3. GIM/GP program may offer funding for
  establishment of academic units
• 4. Geriatrics included within family medicine
  faculty training authority

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Title VII Changes Continued

• 5. Funding priorities in residency training
  program
• a. training disadvantaged and underrepresented
• minorities
• b. training the greatest percentages of
  providers
• which enter remain in primary care practice
  or
• show significant improvements

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Title VII Changes Continued

• 6. Special Consideration - prepare practitioners
  to care for underserved populations and other
  high-risk groups.
• 7. Requirement to produce a plan for measuring
  outcomes

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Title VII Changes Continued

• 8. Authority for a Federal funds matching
  requirement
• 9. Advisory Committee on Training in Primary Care
  Medicine Dentistry to be created

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Primary Care Cluster FY 1999 Funding

• Family Medicine 50,509,000
• General Internal Medicine 18,125,000
• and General Pediatrics

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Administer New Legislation

• To rescind all regulations
• To create workgroup of consultants for each of
  the programs to advise on the implementation of
  the legislation

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Four Legislative Implementation Workgroups

• Academic Units
• Faculty Development
• Predoctoral
• Residency

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Family Medicine Representatives

• Name
  Organization Workgroup
• 1. Edward Bope, MD Riverside FPC/Ohio
  Residency
• 2. John Dickinson, MD Univ. of Rochester
  Acad. Units
• 3. John Frey, MD Univ. of WI Med.
  Sch. Predoctoral
• 4. Larry Green, MD Univ. of Colorado
  Faculty
• 5. Norman Kahn, MD AAFP
  Acad. Units
• 6. Richard Lewan, MD Waukesha Fam. Prac.
  Residency
• 7. David Marsland, MD Medical College of VA
  Acad. Units
• 8. William Mygdal, EdD Faculty Develop. Ctr.
  Faculty
• 9. Douglas Campos-
• Outcalt, MD Maricopa County
  Predoctoral
• 10. D. Ann Travis, MD Premier Medical Group
  Residency

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Osteopathic Representatives

• Name Organization
  Workgroup
• 1. Michael Gallagher, DO Univ. of Med.
  Acad. Units
• 
  Dentistry of NJ
• 2. Sarah Sprafka, PhD Univ. of NE of
  Faculty
• Osteo. Med.
• 3. Anthony Silvagni, DO Nova SE Univ.
  Predoctoral
• 
  Col. of Osteo Med.
• 4. Michael Opipari, DO Health Horizon
  Residency
• 
  System

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Program Focus - Academic Units

• Family Medicine
• To establish new departments of FM expand
  existing departments
• To establish expand the research capability and
  infrastructure of such departments
• GIM/GP
• To establish new divisions of general internal
  medicine or general pediatrics
• To expand the primary care education or primary
  care research of such divisions

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Program Focus Predoctoral Training

• Innovation
• Centers of Excellence
• Establishment or Expansion of Required Clerkships

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Program Focus Residency Training

• Emphasis is placed on national innovations aimed
  at primary care residency education across
  disciplines.
• Innovation is defined as doing something new on a
  national level

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Program Focus Faculty Development Training

• Type 1 Primary Care Clinician Researcher
• Fellowship
• Type 2 Primary Care Master Educator
  Fellowship
• Type 3 Primary Care Faculty Leadership
• Development Fellowship/Training
• Type 4 Community Preceptor Training

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Project Requirements Academic Units

• Family Medicine
• 1. Clerkship - must have required 3rd year
  Clerkship or be proposing to establish Clerkship
• 2. Leadership - Chair must be family physician
  project director named working
• 3. Control of Resources - admin. autonomy
  comparable to other academic units
• GIM/GP
• 1. Leadership-IM/Ped head trained in primary care
• 2. Control of Resources - admin. autonomy
  comparable to other academic units

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Project Requirements Predoctoral Training

• Family Medicine
• Must have a family medicine academic unit
  required family medicine clerkship (of 4 weeks or
  more and prior to students MATCH choice) or
  propose to establish such clerkship
• GIM/GP
• Must have a division of GIM or GP

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Project Requirements Residency Training

• Family Medicine and GIM/GP
• Provide the date and number of accreditation.
• If the project director is not the program
  director, then include a substantive letter of
  support from the program director

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Project Requirements Faculty Development Training

• Family Medicine and GIM/GP
• Will be incorporated into the body of the proposal

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Review Criteria Academic UnitsScoring 0-100

• Family Medicine and GIM/GP
• Overall Quality (30)
• Quality of Existing Proposed Faculty (20)
• Quality of Specific Innovations Enhancing
• the Research Program in Primary Care (20)
• Overall Feasibility Institutional Support
  (20)
• Contribution to Primary Care (10)

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Review Criteria Predoctoral TrainingScoring
0-100

• Family Medicine and GIM/GP
• Overall Quality (20)
• Faculty Leadership Qualifications
• Faculty Diversity (15)
• Institutional Support (15)
• Curriculum Content (20)
• Innovation (15)
• Past Intended Outcomes,
• Eval., Dissemination (15)

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Review Criteria Residency TrainingScoring 0-100

• Family Medicine and GIM/GP
• General Quality (30)
• Innovation (20)
• Quality of Curriculum (20)
• Feasibility (15)
• External Validity (15)

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Review Criteria Faculty Development
TrainingScoring 0-100

• Family Medicine and GIM/GP
• General Quality (30)
• Project Leadership (10)
• Faculty (20)
• Curriculum (20)
• Primary Care Focus (10)
• Outcome Measures Dissemination (10)

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Funding Preference

• Medically Underserved Community (MUC)
• This preference is given to applicants with a
  high rate for placing graduates in practice
  settings having the principal focus of serving
  residents of medically underserved communities
  or, during the previous two years, has achieved a
  significant increase in the rate of placing
  graduates in these settings.

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MUC Preference

• Predoctoral
• High Rate
• Percent reduced from 20 to 15
• Significant Increase
• Threshold lowered from 15 to 10 of graduates
  from the most recent year working in MUCs

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MUC Preference

• Residency
• Significant Increase
• Still requires a 50 increase, but now also
  requires a minimum of 2 graduates working in MUCs

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Academic Units Preference

• The establishment and also the substantial
  expansion of an Academic Unit is continued, but
  the language for the expansion criteria is now
  much clearer.

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Academic UnitsTwo Funding Priorities

• 1. Statutory Funding Priority for
• a Collaborative Project
• between departments of
• primary care - 5 points

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Academic UnitsTwo Funding Priorities

• 2. Administrative Funding
• Priority for Research
• Infrastructure proposals
• - 10 points

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Residency ProgramTwo Funding Priorities

• 1. Primary Care Priority
• A record of training the greatest
• percentage of providers, or
• demonstrating significant improvements
• in percentage of providers, which enter
• remain in primary care practice
• -- 10 priority points

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Residency ProgramTwo Funding Priorities

• To qualify for primary care priority
• a) High Rate - Rate set at 75 1995 grads
• counted in 1998, 1996 grads counted
• in 1999 or
• b) Significant Improvement - Rate of
• primary care practice for 1996 grads
• must be at least 50 greater than the
• rate for 1995 grads AND a minimum of 2
• 1996 grads or 30, whichever is greater,
• is in primary care practice

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Residency ProgramTwo Funding Priorities

• 2. Disadvantaged Priority
• A record of training individuals from
• disadvantaged backgrounds (including
• racial ethnic minorities underrepresented
• in primary care practice)
• a) 5 priority points
• b) Report on current enrollees only
• c) 20 rate to qualify

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Relevance for Reviewers

• Reviewer judgment more valued
• Interdisciplinary peer reviews
• Four separate applications
• Changes in every program
• Interdisciplinary applications
• encouraged
• Knowledge of funded activities

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Primary Care Medical Education Branch Division of
Medicine, BHPr Parklawn Bldg., Rm. (9A-20) 5600
Fishers Lane, Rockville, MD 20857 Phone
301-443-1467 FAX [phone] FAMILY MEDICINE
PROGRAMS Residency Training Faculty
Development Ellie Grant
Elsie Quinones egrant_at_hrsa.gov
equinones_at_hrsa.gov Predoctoral Training
Academic Units Betty Ball
Lafayette Gilchrist bball_at_hrsa.gov
lgilchrist_at_hrsa.gov
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Peer Review Process

• Reviewers recommended to the Peer Review Branch
• Diversity of reviewers
• May serve for three years
• Four to Six weeks to conduct review

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Peer Review Process Contd

• Group Orientation
• Paradigm review of one application
• If principal reviewer
• -- Overview
• -- Evaluation
• -- Assign scores
• Two additional reviewers
• -- Comment and assign scores
• Panel discussion, panel vote

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Peer Review Process Contd

• Budget Discussion
• Vote on Budget
• Vote on funding preferences/priorities
• Reviewers summary is written

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Draft Fiscal Year 2000Grant Review Schedule

• Division of Material Applica- Peer
  Award
• Medicine Download tion Review
  Peer Made
• Programs From Web Deadline Mailout
  Review By
• Residency 7/99 09/13/99
  10/22/99 12/06/99 06/30/00
• Training
  12/13/99
• Faculty 7/99
  10/22/99 12/03/99 01/18/00
  06/30/00
• Development
• Predoctoral 7/99 11/29/99
  01/04/00 02/14/00 06/30/00
• Training
• Academic 7/99 01/06/00
  02/18/00 04/10/00 09/30/00
• Units

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FY 2000 grant application materials available on
the Bureau of Health Professions (BHPr) Web page
on the Internet http//www.hrsa.dhhs.gov/bhpr/gra
nts.html Shelby Biedenkapp, M.S.W. Senior
Program Management Specialist PCMEB, DM,
BHPr 301-443-3615 sbiedenkapp_at_hrsa.gov
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Fiscal Year 1998Budget

• Departments 12 Million
• Predoctoral 9.4 Million
• Residency 13 Million
• Faculty Development 9.2 Million