Health Services Management Curriculum
Overview
The Health Services Management (HSM) Curriculum is an alternative to the other curricula (Traditional, Rural Focus, and Sports Medicine) offered by the Memorial Family Medicine Residency. Unlike the others, it requires four years to complete. The curriculum is arranged so that residents complete the requirements for residency graduation and may sit for their board certification examination in family medicine after completing three years of training, but do not complete the requirements for the curriculum until they complete the fourth year. The additional rotations and time of training prepare the resident physician to serve in the role of manager or administrator of a health organization, in addition to the role of health care provider. Finally, the HSM resident is required to earn the degree of Master of Public Affairs in Health Services Management at Indiana University South Bend, which requires 36 credit-hours of masters level courses.
Content
In addition to the traditional content of a family medicine curriculum, the HSM resident must take 6 ½ management blocks, required half-blocks of hospice, occupational medicine, substance abuse, employee assistance program, procedures, and radiology, and required full blocks of teaching medicine chief, family medicine teaching, and research. The 6 ½ management blocks, which may be taken in any order, consist of rotations in the following areas:
Ethical, Legal, and Regulatory Issues
Financial Management
Health System Integration and Governance
Healthy Communities
Information Systems
Managed Care
Physician Practice Management
Quality Management and Process Improvement.
HSM residents must take at least a half block in each of the above areas, but may expand five areas of their choosing to a full block.
During the fourth year of training, the HSM resident also acts as a preceptor in the FMC one half day a week.
Goal
In addition to the goals of any other overall curriculum, the HSM curriculum shall provide the resident with the skills and knowledge to manage and administer a medical practice or be a member of the management team of a hospital, health system, managed care organization, or other health care related industry.
Objectives for Management Blocks
Ethical, Legal, and Regulatory Issues
The resident will develop an understanding of
* how ethics and law impact the delivery of health care ( SBP )
* principles of autonomy and benevolence (P)
* principles of informed consent and voluntariness (MK)
* competence and capacity and treatment of minors or the incompetent (P)
* risk management ( SBP )
* regulatory compliance ( SBP )
* medical negligence ( SBP )
* physician contracts ( SBP )
Financial Management
The resident will develop an understanding of
* analytical techniques used in the financial management of health care organizations ( SBP )
* rate-setting ( SBP )
* short-term asset management and long-term financial planning ( SBP )
* obtaining and servicing capital and capital project analysis ( SBP )
Health System Integration and Governance
The resident will develop an understanding of
* how and why insurers, hospitals, and physicians form an integrated network ( SBP )
* how integration is a central component of health system change ( SBP )
* how integration can help lower medical care cost, utilization, and expenditures while increasing quality of care ( SBP )
* how integration can lead to increased cost and lower efficiency ( SBP )
* the role of the physician in the governance of integrated systems ( SBP )
Healthy Communities
The resident will develop an understanding of
* the Healthy Communities Initiative (HCI) and its goal to make affordable, high quality, proactive health care available to all residents of St. Joseph County (SBP )
* the various services provided by HCI ( SBP )
* the 40 developmental assets ( SBP )
* how HCI encourages and supports healthy living ( SBP )
Information Systems
The resident will develop an understanding of
* the role of information technology in practice management (PBLI)
* how information technology may transform medical practice in the future (PBLI)
* the challenge of information technology to allow for rapid coordination of care and information sharing ( SBP )
* knowledge-management tools ( SBP )
* the challenge to physicians to maintain patient connectivity in an era when the traditional patient office visit is downplayed (ICS)
Managed Care
The resident will develop an understanding of
* the difference between managed care and other forms of health care organization ( SBP )
* ethical and legal issues confronting managed care (P)
* quality management in managed care (PBLI)
* cost-containment and utilization management ( SBP )
* the role of the primary care physician in managed care ( SBP )
* the role of preferred providers in managed care ( SBP )
* the interplay among access, quality, and cost of health care ( SBP )
Physician Practice Management
The resident will develop an understanding of
* the role of personal finance and wealth management (P)
* office and personnel management (ICS)
* business planning ( SBP )
* the impact of leadership on success in practice (ICS)
* appropriate coding and billing practices ( SBP )
* strategies of cost-efficient patient care ( SBP )
Quality Management and Process Improvement
The resident will develop an understanding of
* the statement “the problems are with the system, and the system belongs to management” ( SBP )
* the three principles of total quality (PBLI)
* a systems approach to quality management (PBLI)
* maintaining an ongoing environment of quality and process improvement (PBLI)
* the importance of teamwork in quality management (PBLI)
* continuous quality improvement (PBLI)
* customer satisfaction (PBLI)
Clinic Staffing
The resident will develop an understanding of
* the role of physician as supervisor and teacher ( SBP )
* the importance of leadership in a large clinic setting (ICS)
Implementation of Management Blocks
Resident rotations are set up by the senior associate director. Residents spend their time with Memorial Health System administrators and managers with responsibilities in the areas assigned and with other preceptors from the community.
Ethical, Legal, and Regulatory Issues
Hospital and Health System Risk Manager
Hospital and Health System Compliance Manager
Hospital Patient Representative
Medical Malpractice Attorney
Professional Liability Agent
Hospital Ethics Committee Member (as 4 th year resident)
Professional Services Contract Attorney
Medicare Medical Necessity
Directed readings
Financial Management
Health System Director of Finance
Hospital Financial Counselor
Directed readings
Health System Integration and Governance
Health System Physician Governance Committee
Directed readings
Healthy Communities
Healthy Communities Initiative of St. Joseph County
Directed readings
Information Systems
Chief Information Officer Memorial Hospital
Director Information Systems
Security Administrator
Directed readings
Managed Care
Community Health Alliance Operations Manager
Utilization Review Case Manager
CHA credentialing
Provider Relations Representative
Primary Care Perspective
Directed readings
Physician Practice Management
Rural Physician Practice Management
Large Specialty Practice Management
Director St. Joseph County Operations Memorial Medical Group
Professional Financial Planner
Directed readings
Quality Management and Process Improvement
Director, Quality Management Memorial Hospital
Physician Quality Assurance Director
Health Care Performance Improvement (Press Ganey Associates)
Hospital Quality Assurance Committee Member (one year)
Clinic Continuous Quality Improvement team member (one year)
Directed readings
Resident Responsibilities
The resident is responsible for notifying the senior associate director one month before the commencement of any HSM block or half-block. After the rotation is arranged, the resident is responsible for being present at the times and places scheduled and for participating in any way requested. The resident is also responsible for doing all the assigned readings and for attending management meetings that occur during the blocks the resident is on an HSM rotation as a second and third year resident and all management meetings (unless pre-empted by a more pressing residency requirement) as a fourth year resident. Those meetings are: Management Committee, every Thursday at 7:00am (including the Medical Directors Meeting, which is every third Thursday at that time) and optional Operations Committee Meeting (Tuesday evenings). The resident is required, to the extent possible, to attend meetings of the hospital quality assurance and ethics committees when assigned. Third year residents will prepare and present one noon conference topic related to health services management and fourth year residents will prepare and present two.
Resources
Required Readings Notebook
Staff Resources of Memorial Health System
Faculty Resources Indiana University South Bend
Community Resources South Bend / Mishawaka / Elkhart area
Methods of Evaluation
Management preceptors complete a form at the end of every block evaluating resident's performance during that rotation.
The knowledge base of each resident will be reviewed on the basis of the resident's performance on the course work taken at Indiana University South Bend.
Each noon conference presentation is evaluated for clarity, content, literature review, ethical issues (if applicable), and applicability to family medicine.
The resident's attendance at assigned committee meetings and management meetings will be reviewed and discussed at the periodic meeting with the team leader.
Rev. 09SEP2008