Operations Cases
The Client
Germane Solutions was contacted by an organization that was operating over its CMS GME cap allotment and struggling to support its existing footprint, but desired to avoid closing any of its programs. The organization sponsors four programs that are a mix of residencies and fellowships. All programs aligned with the strategic goals of the organization and were successful in recruitment, retention, graduate outcomes, and clinical productivity.
The Challenge
Germane Solutions was tasked to effectively right-size the client's GME footprint by reducing as many unfunded resident FTEs as possible without closing any of the programs or impacting key inpatient services that the programs support. Germane Solutions was challenged with measuring resident training costs compared to the funding received by CMS. As leadership did not wish to close any programs, identifying opportunities to reduce resident FTEs while maintaining program effectiveness and quality were crucial for the organization to utilize the whole of their CMS Cap.
The Solution
Through Germane Solutions' GME Program Assessments, ACGME Compliance, and Operational Efficiency Analyses, the consulting team made crucial information more visible for the organization. For example, the GME Program Assessments determined both the operational and strategic value of each sponsored GME program. A review of each program’s ACGME Compliance gave clarity around the educational rationale of provided rotational experiences. The Operational Efficiency Analyses analytically reviewed how each GME program’s resident resources were being deployed throughout the health system at any given time. Once it was determined which GME programs would be affected by this possible reduction in resident resources, new resident rotation modeling was required to verify that resident staffing levels across key services would not be impacted and that residents would still be able to satisfy ACGME requirements prior to graduation. Lastly, the GME Economic Impact Assessment quantified the resulting economic impact to the organization due to the reduction of the resident FTE.
The Germane Effect
Following Germane Solutions’ engagement, the organization now saves $540,000 per year in perpetuity creating a sustainable GME Footprint while all four GME programs remain open. The main primary care residency transferred to a new clinical training model that is predictive and well-leveraged to mitigate unintended consequences from reduction. The resident complement was reduced by five FTEs, allowing hospitals to run closer to their CMS Cap. All inpatient and ambulatory services remained fully staffed without work compression or work-life balance issues while satisfying all ACGME requirements.