UNIVERSITY OF UTAH HOSPITALS AND CLINICS by HboOlYG7

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									UNIVERSITY OF UTAH HOSPITALS AND CLINICS

GRADUATE MEDICAL EDUCATION

2010-2015 PROGRAM LETTER OF AGREEMENT
________________________________________________________________
Insert current date
IHC Health Services, Inc.,
dba Primary Children’s Medical Center



                Re: Resident Training Program Letter of Agreement between Insert Name of
                Program at the University of Utah, School of Medicine and IHC Health Services,
                Inc., dba Primary Children’s Medical Center

Dear Insert Name of Affiliated Hospital Administrator or Executive Director:

This Resident Training Program Letter of Agreement (the “Letter of Agreement”) is entered into between
the University of Utah, on behalf of its School of Medicine (the “School of Medicine”) and
IHC Health Services, Inc. (“IHCHS”), dba Primary Children’s Medical Center (the “Hospital”).

I.             PURPOSE

The purpose of this Letter of Agreement is to document the specifics of the Insert Name of Program
residency training program (the “Program”) at the Hospital, in compliance with the "Essentials of
Accredited Residency of the Accrediting Council on Graduate Medical Education” and the special
requirements of the Residency Review Committee. This Letter of Agreement is also intended to
supplement the Major Affiliation Agreement or Integrated Institutional Agreement between School of
Medicine and Hospital, dated July 1, 2010 (the “Affiliation Agreement”), which is incorporated herein by
this reference, as required by Section 2 of the Affiliation Agreement.

II.            PROGRAM DIRECTOR AND CHIEF OF TEACHING SERVICE

The Program Director for the Program, as designated by the School of Medicine Graduate Medical
Education Committee, is Insert Name of Program Director. The Chief of the Program Teaching
Service at the Hospital is Insert Name of Program Director or Chief at Affiliated Hospital (may be
same person if agreement is with University of Utah Hospitals and Clinics).


Dr. Insert Last Name of Affiliated Hospital Program Director recognizes responsibility to the Program
for all joint education. Dr. Insert Same Name as above has a full-time faculty appointment as Insert
Faculty Rank in the School of Medicine. These appointments are made in accordance with the
Affiliation Agreement.

III.           TRAINING PROGRAM TEACHING STAFF

The teaching staff for the Program at the Hospital (the “Program Faculty”) are:

Insert here a list of the names and faculty ranks of all faculty who will be supervising residents at
this training site


All Program Faculty responsibilities and appointments shall be consistent with the Affiliation Agreement.
Program Faculty assumes administrative, educational, and supervisory responsibility for the residents
while training at the Hospital.

IV.          EDUCATIONAL CONTRIBUTION

The following are expected contributions to the educational goals and objectives of the Program as
provided by the Hospital:

Insert here a description of special expertise, unique patient population, etc. Use your program
Standards of Performance or Goals and Objectives for the rotations at this hospital to specify
what the residents will learn while they are on these rotations. Be specific, the ACGME requires
the training agreement to describe in detail the content of the educational experience.

All patients admitted to the Program teaching service will be available for participation in the teaching
Program. Insert here a description of restrictions if all patients not available.


V.           ASSIGNMENT OF RESIDENTS AND FINANCIAL COMMITMENT TO THE PROGRAM

The number of residents assigned to the Program on a rotating basis shall be: Insert here # per month,
months per year, or hours per week, whatever is appropriate

The period of assignment will be specified in the Resident Rotation Schedule for the applicable year.


INSERT THIS PARAGRAPH FOR AFFILIATED HOSPITALS OUTSIDE THE UNIVERSITY HOSPITAL
SYSTEM:

The Hospital agrees to pay for a total of Insert # here FTE's each year for the above residents for 2010-
2015 housestaff academic years according to reimbursement standards as determined by the Graduate
Medical Education Committee and may report the total number of FTE’s rotating at the Hospital on
Hospital’s CMS cost report. Residents who are funded by the Utah Medical Education Council will not be
billed to IHCHS facilities by the School of Medicine, however they may be claimed on the CMS cost
report when rotating at the Hospital.

It is assumed that one FTE will provide the following kind of coverage:

Insert here a description of coverage. (Note this clause is not about on call coverage, the intent
is to describe the residency coverage of the actual sites where the residents rotate) Example, 1
FTE shall be assigned to the following clinics; orthopedics, specialty and consults, and 3 FTE’s
shall be assigned to the inpatient teams.

Residents will be expected to take call every Insert here frequency of call, i.e. third, fourth day.
Backup call for residents will be provided by Insert here a description, i.e. hospital faculty in house,
or faculty at home, or faculty at UUMC.

The following minimum support services will be available to residents and Program Faculty participating
in the Program:

Insert here a list of support services. Examples: A regularly scheduled series of clinical grand
grounds; conference room and office space for teaching conferences and study; faculty and
housestaff will have the facilities of the Spencer S. Eccles Health Sciences Library in the Health
Sciences Center available, in addition to the [Name of Library] in the [Name of Hospital].

Hospital Program Faculty will have responsibility for teaching, supervision, and formal evaluation of the
 residents’ performance in accordance with the Program Standards of Performance.

 It is understood that all residents participating in the Program will be responsible for the timely completion
 of medical records, and that the Program Director will be responsible to ensure that residents complete
 patient charts in a timely manner.

 VI.          MEETINGS

 Regular meetings of the Program Director, Chief of Teaching Service, and Program Faculty will be held
 to ensure mutual goals and objectives of the Program are being achieved. The frequency of such
 meetings may vary depending on the size of the Program, number of Program Faculty, etc.

 VII.         PERIODIC REVIEW OF PROGRAM

 The Program Faculty will participate in the resident internal review process of the School of Medicine as
 determined by the Graduate Medical Education Committee. The Program Faculty will also evaluate the
 Program annually in combination with the faculty at other training sites and a representative from the
 residency program and the Program will implement improvements to the Program based on these
 recommendations. The following is the Program’s process of Program evaluation:

 Insert here a description of the evaluation process which includes faculty at all sites in evaluating
 the program annually. Note this clause is not about resident evaluation; the purpose is to
 describe how the program is evaluated as per ACGME requirement.

VIII.         RESIDENTS

 Policies and procedures which govern resident education while rotating to the Program can be found in
 the University of Utah and Affiliated Hospitals Housestaff Policy Manual, located at
 http://www.med.utah.edu/SOM/education/GME.

 IX.          RENEWAL

 Hospital and School of Medicine may renew this Letter of Agreement every five years, which renewal will
 be appended to the Affiliation Agreement. This Program renewal will be completed by June 15 of the last
 year in the 5-year cycle, with the renewal to be effective on July 1 for the following 5-year period.

 X.           ANTICIPATED CHANGES

 The parties acknowledge the possibility that Hospital may fund fewer or more positions than specified
 above, and that School of Medicine may deliver fewer or more residents than the number specified
 above. Prior to December 15 of each academic year (July 1 – June 30), the parties will meet by phone
 or in person to discuss and agree upon any such changes in funding or resident numbers for the
 immediately succeeding academic year. In the event changes result from such discussion, the financial
 obligations and FTE’s reported on the CMS cost report, as described at Article V above, will be adjusted
 accordingly through a written amendment to this Letter of Agreement.

 XI.          INSURANCE/INDEMNIFICATION

 The parties acknowledge that all insurance and indemnification questions pertaining to this Letter of
 Agreement are governed by the underlying Affiliation Agreement between School of Medicine and
 Hospital.

 XII.         GRIEVANCE PROCEDURES AND DUE PROCESS

 The University of Utah, the University of Utah Hospital, and the University of Utah Hospital Housestaff
have adopted policies and procedures governing housestaff grievances and due process. This Letter of
Agreement incorporates within it applicable University of Utah Policies and Procedures (available on the
Internet at www.admin.utah.edu/ppmanual), University Hospital Policies and Procedures (available on
the Internet at www.med.utah.edu/policy), and University Hospital Housestaff Policies and Procedures
(available on the Internet at www.uuhsc.utah.edu/SOM/education/gme), including the Housestaff
Counseling Programs policy (which programs include counseling, employee assistance for house officers
and family members, and substance abuse treatment assistance and/or diversion). Housestaff policies
are also available through the Graduate Medical Education Office and at housestaff orientation. Any
changes, updates, or additions, and all other policies and procedures of the University of Utah, University
of Utah Hospital, and University Hospital Housestaff will be posted to the electronic manual websites
referenced, respectively, above, and any changes or updates will be incorporated and effective as of the
date of the change or update.

XIII.        BYLAWS, RULES, REGULATIONS AND POLICIES

School of Medicine shall assure that residents comply with all applicable bylaws, rules, regulations and
policies of IHCHS and Hospital while rotating through the Program.

This Program Letter of Agreement is effective for 2010-2015 housestaff years beginning July 1, 2010 and
ending June 30, 2015.

__________________________________                  ___________________________________
Insert here Program Director Name                   Alan J. Smith, PhD, MEd
Program Director, Insert Name of Program            Assistant Dean and Director, Graduate Medical Ed.
University of Utah, School of Medicine              ACGME Designated Institutional Official
                                                    University of Utah School of Medicine


Please indicate Hospital’s acceptance of the terms of this Letter of Agreement by signing below and
returning a fully executed original to the School of Medicine at the address above.


__________________________________                  ___________________________________
Insert here Affil. Hosp Administrator Name          Insert here Affil. Hosp. Program Director Name
Chief Executive Officer                             Chief of Teaching Service
IHC Health Services, Inc., dba                      Insert here Hospital Name
Primary Children’s Medical Center
                                  CURRENT AFFILIATION AGREEMENTS


INSTI
                              INSTITUTION                          DATE OF AGREEMENT
        Salt Lake Regional Medical Center                          July 1, 2009
        Intermountain Medical Center & LDS Hospital (IHCHS)        July 1, 2009
        Primary Children’s Medical Center (IHCHS)                  July 1, 2009
        Shriner’s Hospital                                         July 1, 2009
        University of Utah Hospitals and Clinics                   July 1, 2009
             A.R.U.P
             The Orthopaedic Center
             Huntsman Cancer Institute
             Huntsman Cancer Hospital
             University of Utah Clinics (community based)
        University of Utah Neuropsychiatric Institute (UUNI)       July 1, 2009
        Veteran’s Affairs Medical Center-Salt Lake City            July 1, 2009

                                CURRENT HOSPITAL ADMINISTRATORS


                              INSTITUTION                              ADMINISTRATOR

        Salt Lake Regional Medical Center                   Jeff Frandsen, CEO
        LDS Hospital & Intermountain Med. Ctr. (IHCHS)      William Hamilton, MD, Medical Director
        Primary Children’s Medical Center (IHCHS)           Joseph N. Mott, CEO
        Shriner’s Hospital (use Shriner’s Template)         Ralph W. Semb, President
        University of Utah Medical Center                   David Entwistle, CEO
        University of Utah Neuropsychiatric Institute       Ross VanVranken, Executive Director
        Veteran’s Affairs Medical Center-Salt Lake City     Robin L. Korogi, Acting Director

             Amended 3/09

								
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