HPE Orientation VERA Educational Support Supplement

1. HPE OrientationVERA Educational Support Supplement Christopher T. Clarke, PhD, FACHE Chief Financial & Informatics Officer

2. It began with a cry of rebellion that went out from the “VERA Education Supplement Workgroup” who declared to Kenneth Kaiser, MD, VHA USH… • “Give me liberty or give me VESS!”

3. And so it was written ‘For the Educators by the Educators”, that in the year of our Lord 19 hundred and 97 the VESS would be established… “To develop a model that allocates funds to the VISNs for supporting graduate medical education and associated health training programs.” “These funds are intended to cover costs directly associated with training medical students and other health trainees as well as medical residents.”

4. And it was further written that VESS was destined to provide solace and support for Education Office Staff in its use for • “The portion of salary of VA staff who are instructors for residents and trainees (paid and unpaid) in all approved training programs”; • “Administrative support such as personnel, supplies, accreditation fees, books, and other program costs necessary to manage clinical education programs.”;

5. And so the VESS came to pass and flourished… • 1997 - Original Model developed by “VERA Education Workgroup” in 1997 and implemented in FY98… funding allocated to VISN’s based ONLY on GME Positions. • 2010 – VESS funds became a “Pass-Through” - funds were sent directly to VA Medical Centers. • 2015 – New VESS model was developed and approved that included Associated Health positions in addition to GME positions. • 2017 NLC recommended full implementation of new model without a phase or trial in period.

6. And it is often asked by the good Education People …“From where Doth it Come?” • Know that it is requested by good OAA as part of VHA’s Presidential Budget; • It has been set equal to Direct Trainee Budget; • Yet it goeth to the money gropers in the Allocation Resource Center for distribution with general VERA Funding; • And behold, it thus becometh part of General Medical Center Budget;

7. “Not a visible enthusiasm but a hidden one, an excitement burning with a cold flame.” Patrick Suskind And lo this wealth is hidden from thine eyes, but despair not for it shall be revealed to thee If ye believe and seek it!

8. You will find this treasure on the ARC Website: http://vaww.arc.med.va.gov/ • 1. Information and Reports • 2. Medical Center Allocation System (MCAS) • 3. Ye may need to ask a wizard to gain access to this treasure, as it is not commonly known among the common folk… but then you are not common folk!

9. And then a New Model was needed “The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking.” Albert Einstein

10. New VESS ModelWhy? • Recommended by National Academic Affiliations Council (NAAC) and accepted by VA Secretary; • Incentivizes facilities to invest in both GME and AH training; • Partially relieves inequity for smaller facilities that don’t have GME but have AH programs, and not been eligible for VESS; • Aligns VESS to match the reality of a VAMC’s entire clinical training portfolio. • Need for financial model supporting full range of clinical education activities at an MC.

11. A Few VESS Statistics

12. 5 Year Funding Trend

13. Amount Per Trainee5 year values

14. Calculating the VESS 1. Divide Total VESS Budget in 2 funding pools using split percentage from total obligations for prior FY: • GME Obligations • All Other Trainee Obligation (for AH/RN/Dental/AF) 2. Derive separate GME & AH National Price Factors • GME Cost Factor = GME Funding Pool/Total GME FTE • AH Cost Factor = AH Funding Pool/Total Non-GME FTE (position hours/2080) 3. Calculate Facility Allocation • (# of Local GME * GME Cost Factor) + • (# Non-GME * AH Cost Factor) = • Total Facility VESS Allocation

15. FY19 VESS Calculation

16. New VESS ModelIs it Misunderstood?

17. Confused? Questions Accepted