Frequently Asked Questions About Brody & ECU Physicians
Financially, how did ECU Physicians close out the fiscal year that ended on June 30, 2014?
Based on the operations of ECU Physicians, the practice lost $12.4 million. This is not sustainable and cannot be repeated in this new fiscal year (2015).
How does the budget proposed by the N.C. General Assembly affect Brody?
We will continue to review overall budget outcomes - including changes that affect our partners at Vidant - before we can determine the specific outlook for Brody. Based on our preliminary analysis, the legislature is responding positively to our concerns on specific critical legislation affecting the Brody School of Medicine. The proposed budget reinstates, in part, the ability of our clinical practice to collect debt through the Set-Off Debt Collection Act (SODCA) as well as provides additional access to federal Medicaid funding by making adjustments to the Upper Payment Limits (UPL) to providers. Also critical is the fact the proposed budget did not assess a tax on the UPL funds we receive.
In light of the difficult fiscal situation, can and will the medical school survive?
Yes! While changes must occur, the school’s leaders are committed and confident that we will succeed, if we make the necessary changes on a timely basis. Our current revenues cannot sustain all the things Brody has been doing. We are doing the current work in order to support our mission.
Departments, units and programs are being reviewed and identified as “core” or “essential.” What makes something “core” or “essential” at a medical school? Are there things beyond that which are “core” to Brody?
The Liaison Committee on Medical Education (LCME) is the accrediting body for all U.S. medical schools. LCME requires that all medical schools provide, at a minimum, the following in order to qualify for accreditation:
Brody will meet and exceed all of the minimum LCME accreditation requirements listed above, and will also continue to emphasize a focus on primary care, which is a key aspect of our mission.
Beyond this, fulfilling the Brody mission requires the medical school to serve the needs of eastern North Carolina by assuring that we also provide:
What will happen to areas, and the employees in those areas, that are determined to not be “core?” When will the decisions be made?
Where ECU Physicians has been providing funding for programs, units and services determined to not be core to the educational or service mission of Brody, other funding sources will need to be secured. Better aligned funding or revenue sources will be explored and sought for these important programs, even if they do not meet the definition of core for a medical school. Potential sources of revenue will vary from case to case, but will likely include the community, Vidant and non-state government and philanthropic options. These decisions will occur over a period of months.
In some cases, more appropriate funding sources may be secured through grants or contracts, with staff and faculty retained as ECU Physicians employees. In other cases, a different source of funds may require a change in the employment of staff and/or faculty to another entity, which may include the establishment of new private practices. For those programs where ECU Physicians funding will end and new sources of funding cannot be secured, the program or service will end. Employees may be transferred to suitable vacant available positions or laid-off, with eligible and appropriate benefits and support in seeking new employment being provided to those employees.
I hear that some agreements may transfer certain non-core units or services to the hospital or to the community. How will that work? What will happen to staff and faculty? Will affected faculty be able to retain academic titles and tenure?
Brody is working closely with our partners at Vidant. As these services are evaluated, Brody and Vidant will jointly evaluate the possibilities of those services being assumed by Vidant. There are two basic ways that Vidant may assume the financial responsibility for those services:
How will any of the changes being considered affect individual’s employment and income?
Positions within ECU Physicians and other positions funded in whole or in part with revenue from ECU Physicians are being reviewed to determine whether any changes in compensation (including increases) are appropriate. For clinical faculty, compensation levels will be aligned to their level of clinical productivity. Clinical faculty will receive specific targets consistent with national benchmarks that must be achieved to receive compensation at specific levels. Compensation levels will be adjusted up or down accordingly. If productivity is consistently and persistently inadequate, termination is a possibility.
I understand that the clinical portion of faculty members’ compensation will be based on wRVU’s (work Relative Value Unit). If so, can compensation be calculated on a “team” basis rather that a strictly individual basis so young faculty have an opportunity to build practices?
We are looking at ways to create incentives to improve productivity, not just for individuals, but for entire units, where that is appropriate. With this in mind, we are looking at multiple ways to calculate compensation, including ways that provide younger/newer faculty opportunities to build their practices. Suggestions on how to best structure such incentives are welcome and should be discussed with your department chair.
In calculating compensation, how will non-clinical responsibilities, such as administration, teaching and research, be considered and included?
The evaluation and analysis of every position employed by or paid (in whole or in part) with revenues from ECU Physicians includes a review of the portion of time the position dedicates to non-clinical responsibilities. Non-clinical responsibilities, like administration, teaching or research will be realigned to be properly paid from appropriate funding sources for those activities. For example, state funds appropriated for teaching will be realigned by formula to pay directly for the time individual people/positions conduct teaching-related activities, including preparation. In other words, every aspect of a clinical faculty member’s time must have a specific funding source to cover that percentage of their compensation.
What are the new Ambulatory Access Standards? Why do we need them? What do they cover?
The Ambulatory Access Standards will enhance how we work with patients in our clinics in a number of ways. The standards will create more uniformity of patient appointment schedules, clinic operating hours, lengths of appointments, dealing with No Show patients, and many other vital operational details. The overall intentions with the standards are basically three-fold: to provide the highest quality of patient care and ready access to appointments; to provide an outstanding work environment for our providers and clinical staff; and to provide long-term financial stability for ECU Physicians. The Standards also recognize the importance of operating ECU Physicians as a business, an approach that is essential for our long-range stability. The Standards are a fundamental step as ECU Physicians becomes a true group practice, rather than a federation of separately managed clinics.
Research is important to the University and to the Hospital. How will research be encouraged and incentivized?
The Brody School of Medicine will continue to encourage faculty to undertake government and corporate funded research. Faculty can, and should, pursue any available intramural funding opportunities offered by ECU, as well as those offered by foundations in the region and nationally. Unfortunately, we can no longer afford to cover research expenses from the clinical practice.
How effective is the collaboration between Brody and Vidant?
The Brody relationship with Vidant is strong today and strengthening. There is an explicit realization by executive leaders in both organizations that the paradigm-shifting changes occurring in healthcare are best met by Brody and Vidant working collaboratively and cooperatively. Both Brody and Vidant are undertaking similar evaluations, analysis and streamlining of their respective organizations. As we both work through that process, we are working closely to ensure that an action taken by one party is communicated and understood by the other organization. This will minimize or eliminate the impact to employees, students, patients, and the community. Both Brody and Vidant will emerge from this process stronger, working better together and much better positioned to lead eastern North Carolina into the future of health care.
What is the vision of where the Brody School of Medicine and Vidant will be in 2 years? In 5 years?
Brody will have worked through the dramatic changes in health care and will have succeeded in transforming ourselves to assure financial sustainability and greater self-reliance, while continuing to deliver on our historic mission. In so doing, Brody will be in an enviable position to shape the future of health care in eastern North Carolina and to serve as a national model. The transformation on which we have embarked will ensure Brody has the ability to make needed investments in people, equipment, facilities and new ways and structures to deliver on our mission.
In 5 years, Brody will be at the center of a changed health care landscape in eastern North Carolina, in partnership with key allies. Physicians and hospitals will be more effectively networked together to provide comprehensive care to patients – both those who are sick and, increasingly, those we are helping to keep healthy. These physician-led networks, whether they will be called Accountable Care Organizations or something else, will be organized for the benefit of patients through a Patient Centered Medical Home (PCMH) with ubiquitous use of Electronic Health Records (EHR). These new ways of delivering care will provide Brody with new and better ways to train doctors in our eastern North Carolina communities. These Brody-trained doctors will continue to practice in eastern North Carolina in large numbers and, in turn, transform health care.
It has been said that some level of RIFs (Reduction in Force) will occur. Is that true? If so, how many jobs will be lost and when will people be notified?
Yes. Some level of lay-offs will occur. We are currently evaluating every position in ECU Physicians as well as every position elsewhere in Brody funded (in whole or in part) with ECU Physicians revenues. While evaluation of further cuts will continue for some time to come, the first round of cuts required to assure financial sustainability will be about 100 positions. Of these, approximately 90 positions are being eliminated through attrition. That means approximately 10 jobs that people currently hold will be eliminated. Affected employees will be notified as soon as decisions to eliminate specific positions are made. We expect that will begin in August.
In addition, on a case-by-case basis, as non-core programs and services are realigned with more appropriate funding sources or transferred out of ECU Physicians, additional RIFs may occur. Most of these “RIFs” will actually be changes of employment to another organization. We hope these cuts, along with other financial controls and operational changes we are implementing across the practice plan, will suffice to establish financial sustainability. However, we will continually evaluate ECU Physicians’ financial position to determine if additional reductions in work force are required.
If the legislature approves salary increases for state employees, will that increase be extended to the ECU Physicians CSS employees?
The dean and ECU Physicians leaders have decided that unless the specific language in the legislature’s approved budget bill prohibits it, CSS employees of ECU Physicians will be awarded the same salary increase for which Brody employees are eligible.