GME Finance and CHCsKiki C. Nocella, PhD, MHA

Background and Experience

• Faculty at University of Southern California – Department of Family Medicine• Founding Vice Provost of Health Affairs – University of California,

Riverside• Founder of Believe Health and KCN Consulting 2008-present• Contracted with The George Washington University for the evaluation

of THCs • Have developed almost 100 residency programs and consortiums for

states, regions, hospitals, and FQHCs.

Sources of Residency Funding• Medicare GME Funding through the training hospital • IME (added onto DRG)• DGME (paid directly to hosp or CHC)

• State GME Funding• Grants/Stipends from funders, medical schools• Patient care revenue• Institutional support• (direct contribution and in-kind)

• HRSA THC-GME grants

Understanding a residency program’s finances

Total

Faculty Practice (ambulatory, not

precepted)

Resident Clinic (Precepted Ambulatory

Visits)Resident

Inpatient Service Residency

N/A N/A N/A

Models of Relationships

• Hospital Sponsored• CHC Sponsored• CHC as Continuity Practice• Rural Training Track (aka 1:2 program)

Considerations for CHCs planning residencies• Cultures of service and education• BPHC requirements and ACGME requirements• Scope of services• Relationships with hospitals• Richness of education• Exponential community value• Improved P/L