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Good Learning for Good Healthcare in Safety Net Institutions
Background and Overview On July 30, 2004, the Accreditation Council for Graduate Medical Education (ACGME) and the Association for Academic Health Centers (AHC) co-sponsored an invitational symposium, Good Learning for Good Healthcare in Safety Net Hospitals. Safety net hospitals provide access to healthcare for many of the country’s poor, under-insured, uninsured and vulnerable populations. In addition, many also sponsor residency programs and train a substantial number of residents; unfortunately, many of these institutions have had chronic problems complying with ACGME standards. Safety net institutions have also come under increasing financial pressure in recent years as Medicare and Medicaid payment have shrunk and the number of uninsured has increased. In order to better understand why some safety net institutions succeed in their educational missions while others struggle, even though all seem to be facing similar challenges, we invited key leaders from a sample of institutions that have had varying levels of success with these issues. Defining “Safety Net” Although a single commonly accepted definition of the “safety net” does not exist, the Institute of Medicine (2000) defined safety net providers as:
Those providers that organize and deliver a significant level of health care and other related services to the uninsured, Medicaid, and other vulnerable patients. These providers have two distinguishing characteristics: (1) by legal mandate or explicitly adopted mission they maintain an “open door,” offering access to services to patients regardless of their ability to pay; and (2) a substantial share of the patient mix is uninsured, Medicaid, and other vulnerable patients.
Goals and Objectives The particular goals of the symposium were as follows:
Identifying Participants for the Symposium Safety net institutions were identified using Medicaid Disproportionate Share (DSH) payment data available from the Center for Medicare and Medicaid. The list was supplemented with: (1) institutions that were also members of national safety net advocacy organizations (e.g., the National Association of Public Hospitals and Health Care Systems, the California Association of Public Hospitals, and the National Association of Urban Hospitals); (2) sponsoring institutions that had long standing affiliations with safety net hospitals (e.g. Emory University and Morehouse School of Medicine were included due to their long standing relationship with Grady Health System), and; (3) institutions identified by the ACGME staff. In total, 117 institutions were identified as either safety net institutions that sponsor/support residency training programs or institutions that had strong affiliations with safety net institutions. The chief executive officers and designated institutional officials of these institutions (approximately 230 candidates) were mailed an invitation to attend the symposium in May. A total of 66 individuals attended the symposium. Participant list. Symposium Notes Symposium Evaluation At the end of the symposium participants were asked to evaluate the overall event and key components. From the feedback received, it seems that overall participants were satisfied with the symposium and had positive things to say about it and the invited presenters. However, a number of attendees commented that the goals were only partially met due to a heavy and somewhat overly structured symposium agenda. It was suggested that future symposia be longer, possibly 2 days, and have time set aside for open discussions. It was also recommended that future invitees be solicited to provide input on devising agenda/discussion items. For a full review of the comments received along with an analysis of component components please click evaluation of comments. For a presentation on the symposium please click overview and evaluation. We appreciate and are grateful for all the feedback received. Future symposia on this issue will be better planned, organized, and implemented as a result of this information. If you have any questions about the symposium please contact Jerry Vasilias, PhD, at jvasilias@acgme.org, or (312) 755-5015. |
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