Mission Support Analysis September 2018 Patrice “Patrick” Delafontaine, MD Hugh E. and Sarah D. Stephenson Dean, MU School of Medicine Professor of Medicine and Medical Pharmacology & Physiology OPEN-HEALTH AFF-INFO 4-1
Funds Flow Presentation Agenda Key Questions – Mission Support for Research & Teaching • – What are the mechanics of funds flow distribution from MUHC to the School? – How does the School of Medicine allocate funds to support research & teaching? – How Does the allocation align with strategic needs of the School & mission of the University? • Funds Flow Model Definition – Common AMC Funding Model – Role of School, Faculty Practice Plan and Medical Center in Funds Flow – MU Funding Model • SoM/MUHC Sources & Uses of Funds for Teaching, Research & Clinical Services – Clinical – University Physicians Generated Funds – Administrative - – Academic Achievement Support – Teaching – Medical Students, Residents & Fellows – Strategic funding OPEN-HEALTH AFF-INFO 4-2
Funds Flow Model An Overview of Medical School Funds Flow: All three missions of a medical school—research, education, and patient care— are interdependent, and each supports the others. Each school has its own unique mix of revenue sources and expense sharing among the medical school, faculty practice plan(s), parent university, and affiliated hospital(s). Despite these differences, revenues from clinical care subsidize research and education missions at every medical school. Clinical revenue for the SoM and MUHC is generated primarily by the faculty of the School of Medicine. A portion of the clinical revenue they generate for the hospital is sent back to support the mission of the school via the funds flow model. Academic Medicine 2012 Dec; 87(12):1746-51. doi: 10.1097/ACM.0b013e3182713b77. Perspective: follow the money: the implications of medical schools' funds flow models. Miller JC 1 , Andersson GE, Cohen M, Cohen SM, Gibson S, Hindery MA, Hooven M, Krakower J, Browdy DH OPEN-HEALTH AFF-INFO 4-3
Mission Support Definitions MU Adopted the CARTS Model for Funds Flow in 2004 CARTS as a Funds Flow Methodology: “C” - Clinical programmatic support & new clinical program investment “A” - Cost Report Medical Directorships and time commitments “R” - Academic Achievement Funds to support research & academics “T” - Teaching assignments and time commitments “S” - Strategic support: mission-critical clinical programs that cannot otherwise support themselves, recruitment ramp up The School of Medicine implements this methodology via: CARTS allocation process from MUHC for clinical & administrative funding Academic Achievement Support from MUHC Agreement for research funding Mission Based Mgmt. Funding Model distributes funds for teaching Grants Management with OSPA for Sponsored Research OPEN-HEALTH AFF-INFO 4-4
MU Funds Flow Model FY19 The comprehensive funds flow model for the School of Medicine consists of multiple sources including MUHC but research sponsors and the University are key sources of mission support Main School of Medicine Revenue Sources SoM University of Funded Research MU Health Care University Missouri Sponsors Physicians Mission Grant Dean & GRA OH Expend. Support Clinical Inst. F&A Alloc. Support School of Medicine Distributes Academic & Clinical Support Funds Admin. Strategic Clinical Teaching Research Clinical Departments Basic & Clinical Science Departments OPEN-HEALTH AFF-INFO 4-5
Total Funds Received from MUHC for Mission Support Mission Support funds the School receives from MUHC are allocated by MUHC and SoM leadership. Academic Achievement funding is reserved for research and teaching and are allocated based on NIH funding potential, research infrastructure, scholarly pursuit needs and related research and academic mission support needs. Total MUHC Clinical Mission Administrative Teaching Strategic Academic Recruitment Support Services Mission Initiative Achievement FY 16 62,520,627 27,508,976 6,488,472 2,655,612 8,072,352 2,545,215 15,250,000 FY 17 65,151,780 29,654,902 7,222,547 550,004 8,287,102 2,377,225 17,060,000 FY18 64,432,398 28,363,020 6,380,219 308,460 8,580,152 2,800,547 18,000,000 FY19* 65,000,000 31,129,383 7,797,681 500,000 9,109,051 1,463,885 15,000,000 Total $ 257,104,805 $ 116,656,281 $ 27,888,919 $ 4,014,076 $ 34,048,657 $ 9,186,872 $ 65,310,000 Note * FY19 Recruitment & Academic Achievement funds are estimated amounts based on current budget projections OPEN-HEALTH AFF-INFO 4-6
Allocation of funds to support Research and Teaching pursuits for the School of Medicine OPEN-HEALTH AFF-INFO 4-7
FY2018 School of Medicine Faculty FTE SoM Faculty divide their time into 3 major categories – Research, Teaching & Clinical Faculty Count is Grouped by Main Mission Similar to all medical Schools, MU has a larger number of clinical faculty than research faculty – this is due to market and funding requirements of the SoM and their AMC OPEN-HEALTH AFF-INFO 4-8
FY17 Public Medical Schools Revenue By Source Current “Typical” AAMC Member SoM Revenue Sources Fully-Accredited Public Medical School Revenue by Source, 139 Medical Schools. Source: LCME Part 1-A Annual Financials OPEN-HEALTH AFF-INFO 4-9
MU SoM FY18 Revenue Sources: $385M Academic Support 18,777,929 5% CARTS 43,958,313 11% Clinical 228,918,965 59% Gifts 7,291,676 2% GRA 46,023,127 12% Research & Academic Research & Grants 40,751,064 11% Grants Support Total 385,718,072 11% 4% CARTS GRA 12% Gifts 12% 2% Clinical 59% MU SoM Revenue Sources are more reliant on directly generated clinical funds to cover teaching, research and clinical pursuits than its peers OPEN-HEALTH AFF-INFO 4-10
FY18 Actual Expenditures: $376M Administrative 25,213,849 7% Strategic 20,569,312 5% Clinical 235,620,958 63% Resident - Teaching 10,104,938 3% Teaching 32,076,314 9% Research 52,048,238 14% Administrative Strategic 7% Total $ 375,633,609 4% Resident - Research Teaching 14% Teaching 3% 8% Clinical 63% OPEN-HEALTH AFF-INFO 4-11
5 Year Clinical Revenue From Patient Care (in Thousands) SoM University Physicians Practice Plan Clinical Revenue is a separate component of funds flow and is governed by CRR 440.040 University Physicians Summary FY2014 FY2015 FY2016 FY2017 FY2018 Sources: Net Professional Fee Charges $440,375 $468,908 $513,286 $550,477 $558,085 Net Professional Fee Collections $162,773 $173,849 $191,265 $204,871 $206,288 Uses: Net UP Direct Operating Expenses per 440.040 17,008 18,333 21,443 23,606 24,006 Net Teaching, Research & Clinical Faculty Support 32,545 37,452 35,693 35,004 30,583 Net Deans Office Account Funds 9,390 10,043 11,095 11,634 11,600 Professional Liability 7,666 7,504 7,105 7,722 5,144 440.040 B: Faculty members of the School of Medicine of the University of Missouri may be engaged in one or more of the following employment duties: teaching, research and patient care . Patient care is an integral part of the educational mission of the school for it provides to the instructor and the medical student the clinical experience essential to medical education . OPEN-HEALTH AFF-INFO 4-12
Clinical Support (CARTS “C”) FY16 FY17 FY18 FY19 452000 - CARTS C $25,908,976 28,054,902 26,443,020 29,209,383 • CLINICAL MISSION: 4yr approx: $116.6M Support for clinical departments’ services to address clinical missions of SoM and MUHC. • Salary support (but not incentive) is applied to faculty, advance practice providers and to ancillary support for clinical operations • Funding determinations are based on departmental requests for both specific services and programs, and support for projected budget deficits due to clinical market compensation costs not sustainable through patient collections only. • Clinical departments that routinely receive support include: • Anesthesiology, • Child Health, Dermatology, • Family and Community Medicine, • Internal Medicine, • Ophthalmology, • Pathology, • Surgical services for pediatrics OPEN-HEALTH AFF-INFO 4-13
Administrative Support (CARTS “A”) 452000 – Administrative FY16 FY17 FY18 FY19 Services 6,488,472 7,222,547 6,380,219 7,797,681 ADMINSTRATIVE SERVICES: • Compensation for clinicians identified as a Medical Director at University Hospital, Women’s & Children, Bio-Joint and MOI is based on base salary only. Level of support to be provided and accountability are determined by the Chief Medical Officer and approved by the Dean and CEO. A Directorship Memorandum is signed by each director acknowledging their expectations. • Support for MUHC related administrative responsibilities for clinical department chairs for oversight and coordination of the clinical mission . OPEN-HEALTH AFF-INFO 4-14
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