Finance

GME Financial Models & Proforma Development

We take your vision for GME development or expansion and explore the financial options to economically and sustainably see your vision realized.

At-Risk/CMS Cost Report Review

We partner with your CMS Reimbursement team to review CMS Cost Reports to ensure accurate Resident FTE counts, identify additional reimbursement opportunities, and minimize audit risks.

Rural Designation

With the recent changes to the anti-stacking rule, the Rural Designation Strategy can be an opportunity for previously capped hospitals to create new GME funding. We will work with you to determine the feasibility of changing provider designation from Urban to Rural designation. Germane will ensure that you understand short-term and longer-term impact as well as the required timeline for this complex strategy.

GME Profiles & Business Cases

We partner with you to better understand location-specific financial considerations of building new GME programs, altering the size or mix of program, and redistributing GME programs across various landscapes. Our work across the country has provided us with significant experience with programs in traditional and non-traditional settings, such as Federally Qualified Health Centers, Private Offices, University Systems with multiple hospital partners, and National Healthcare Systems with operations in multiple states.

GME Affiliation Agreement

We act as a conduit within single health systems or between multiple academic medicine partners to create a partnership between entities that allows for CMS cap or other resource sharing to support the advancement of GME for all parties.

These case studies provide insight to how we put these offerings together to create value for you.

Finance Case Study: How Do We Obtain & Build Upon Our GME Funding Opportunity?

Germane was contacted by a medical school client to evaluate the financial outlook of one of their partner hospitals to determine impacts of starting a new GME program within their hospital.

The Challenge:

Germane is tasked with performing an unbiased GME Business case for starting a new GME program at a non-teaching hospital. This GME Business case performs a few factors, such as checking for previous GME activity and evaluating the relationship. If a hospital wants to add or advance any programs, an investigation must take place to outline foundational programs that are needed as requisites. Additionally, for any new potential program of interest, a proforma ought to be conducted to provide hypothetical financial data. Lastly, to capitalize on all monetary opportunities, Germane will identify any applicable grants or the like.

The Solution:

GME Profiles were created by Germane for the hospital in question to understand specific financial information in regard to building new GME programs. An Institution-level Aggregate 10-Year proforma was conducted to identify the hospital’s foundational programs. Consequently, and as previously mentioned, this helps this hospital formulate what programs it can realistically advance. Similarly, the proforma illuminates future financial information for these new programs. Germane also found applicable state and private funding opportunities to improve the hospital’s financial outlook.

The Outcome:

Through these factors, the medical school and their partner hospital greatly benefitted: GME programs were sustainable with a modest ongoing investment from the sponsoring hospital. As both an outcome and solution, the hospital benefits from the strong, unified support it has with its medical school partner. From this relationship, every resource from each partner can be more efficiently utilized.

Finance Case Study: How Do We Ensure Our GME Funding is Completely Maximized?

Germane was contacted by a small hospital system consisting of 4 hospitals. Within this hospital system, their flagship hospital contains legacy residency and fellowship programs through an affiliation with a local medical school, one has previous cap issues, and the other two are non-teaching hospitals. Health System leadership was interested in learning how to optimize the current resident operations at their flagship teaching hospital and work to grow the GME footprint in their non-teaching hospitals to meet their organizational goals.

The Challenge

Germane is challenged with identifying and receiving all applicable GME payments from previous Medicare Cost Reports. If needed, Germane will help the small hospital system refile these cost reports. A CMS Cost Report Review was conducted by Germane to evaluate the hospital’s FTE count. Of course, communication with CMS will be crucial along this process. Another challenge is making use of the entire hospital system to work as efficiently as possible.

The Solution:

To validate the Resident FTE count, Germane partnered with the hospital system to correct the counting process and ensure minimal audit risk. In regard to growing the hospital system’s GME Footprint, Germane will work with leadership to develop financial considerations and incentives for new GME programs. Also, Germane modeled the system’s GME development to navigate any financial opportunity. 

The Outcome:

The small hospital system benefitted in many ways. To begin, Germane was able to correct their Resident FTE Counting Process, and this resulted in the hospital system receiving an additional $6 Million in CMS Reimbursement. With this extra funding, monetary investments were appropriated to new resources, technology, capital development, and faculty raises. As an indirect effect, these investments increased faculty satisfaction within the hospital system.