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Justifying a Residency Program Justifying a Residency Program and Showing a Return on and Showing a Return on
InvestmentInvestment
Janet Teeters, M.S.
Director of Accreditation Services
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Objectives:
Why ↑ demand for residency positions Why you might want to start or expand a program Financial and non-financial elements to consider
when justifying a program
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Pharmacists in 2020
PharmacogeneticsGene TherapyNano TherapyMolecular Target Therapy
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To support the position that by the year 2020, the completion of an ASHP-accredited postgraduate-year-one residency should be a requirement for all new college of pharmacy graduates who will be providing direct patient care.
ASHP Position Statement approved June 2007
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Residencies are the bridge between Education and Practice
Helping to develop clinical & professional maturity
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What’s Happening with Residencies?
Although we are growing more programs, the demand by new graduates is higher than the supply. Market conditions are changing and employers are seeking ASHP accredited residency trained pharmacists.
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Pharmacy Organization Support for Residency
All of these organizations are partners with ASHP at the ASHP Commission on Credentialing table.
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Demand from new graduates Pharm. D. entry level degree –everyone has the same
degree and individuals need to find a way to differentiate themselves. Additionally colleges are graduating an increased number of students.
“Ideal job” requires residency training Many jobs, not just ideal jobs, now require residencies
(e.g. Health systems) ~19% of new graduates complete a residency, but even
higher numbers seek them Current Economy has tightened up the number of jobs,
while the number of graduates increases,
managers can be more selective in
requiring residency trained individuals
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PGY2
Administration Nuclear
Ambulatory Nutrition
Cardiology Oncology
Critical Care Pain/Palliative Care
Drug Information Pediatrics
Emergency Medicine Pharmacotherapy
Geriatrics Psychiatry
Infectious Diseases Solid Organ Transplant
Informatics
Internal Medicine
Medication Use Safety
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Opportunities to meet the demand
Increase # Residency Programs
Increase # Residency Positions
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Why start a residency?
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There must be perceived value…Human Resources side
Recruitment
Retention
Residents cover some staff shifts
If hire your resident No recruitment fees
No interview fees
Advertisement
No outside recruiters Reduced Training costs No relocation expenses You know the person
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Perceived value… Service
Residents expand your normal scope of service
Improve patient care
Keep services and staff progressive
Residencies tend to drive innovation
Projects
CQI
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Perceived value…Cost AvoidanceImproved Financials
P&T (therapeutic substitution)
DUE
↓ Medication Errors/ ADR
↑ Interventions
Special Projects focusing on cost reduction
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Perceived value… Education
Precept Students
Education for Techs, R.Ph., RN, MD
Interdisciplinary focus
Improved credibility
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If perceived value: How to begin?
Initial assessment Costs of the program Support for program Part I Core Elements Program Design Individuals Role Part II
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Initial assessment Organization
– Mission/Philosophy – does it include education?– Patient types & Volume – do you have enough variety and
volume to support a program?
Department– Staff (experience, interest, commitment, presence)– Services (wide scope & depth)– Complete ASHP Pharmacy Practice Model Initiative (PPMI)
Hospital self assessment (if a hospital)
http://www.ashpmedia.org/ppmi/ Complete “RU Ready”
http://www.ashp.org/menu/Accreditation/ResidencyAccreditation/RUReadyTool.aspx
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Costs of a residency program
Preceptor and program directors time Space and equipment Stipends & benefits of residents Travel Recruitment expenses Training of Preceptors Accreditation Fees
You will need detail to receive CMS funding
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Gathering support
Pharmacy Physicians Nursing Administration
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Business Plan
Description Market analysis Costs Value to offset costs (intangibles and financials)
CMS Inpatient Reimbursement Pass through funding for hospital run pharmacy residencies, if you meet their criteria, and are ASHP accredited
Executive Summary
Refer to your hospital for their format
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Costs – 2 residentsResidents stipend & benefits $87,500
(2 residents @ $35,000 +25% benefits)Travel $ 4,000
(2 residents MCM, Regional Residency Conf)Accreditation Fees $ 3,655
(2010: $780 application fee 1X & $2,875 annual assessment -1 program) Residency Program Director $ 8,600
(4hr/week X $43/hr x 50 wks)Preceptors $21,500
(10hr/week X $43 x 50 wks)MISC – copying costs, etc. $ 1,000Residency Showcase $ 555
TOTAL $126,810
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Offset Costs (2 residents)
CMS Funding (PGY1 only) – direct costs $63,405(Est same % as Medicare Pts $126,810X 50%)
CMS Funding indirect costs $ 25, 362 (see your finance dept 20% of directs?)
Staffing commitment (not paying RPH) $ 34,944 (Every other Weekend 16hr/wk x 52 weeks x $42/hr RPH Shift diff)
Sub total $123,711Once established:Projects that reduce costs (therapeutic substitutions, DUE) ????Hire 1 resident (soft costs)
↓ recruitment $ est $15,000, ↓ training time 3 months 480 hr X $40/hr est $19,200 $34,200
SUBTOTAL $157,911
Versus costs $126,810
This does not address intangible benefits
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Include intangible benefits
Innovation
Progressive staff
Recruitment & Retention
……
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Where’s the $ coming from?
One-time start up costsGrants (Foundation, state, college, industry)
Vacant FTE 1RPH ~ 2 ResidentsRN, MD vacancies
Partnersshared cost
Justification may be enough
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How will you justify or show a return on investment of your residency?