Jessica L. O'Hara
The Alliance for Academic Internal Medicine (AAIM) released Thursday, June 17, 2010, a set of principles that outlines the shortfalls of Medicare’s financing of graduate medical education (GME) and propose several recommendations to address these concerns in view of the nation’s current health care needs. The AAIM Principles for GME Reform address several issues, including the current physician shortage and expansion of Medicare-funded GME positions, the inadequacy of Medicare GME payments, and Medicare GME support for all training time of residents and fellows.
The release of the principles occur in light of the current state of Medicare GME financing and the Medicare Payment Advisory Commission’s (MedPAC’s) June 2010 report, which was released Wednesday, June 16, 2010. AAIM’s five principles for GME reform are:
· Medicare GME payments should be strategically utilized to address physician workforce and societal needs.
· Medicare GME payments should be adjusted to reflect the costs of training residents and fellows in the 21st century.
· All payers should explicitly support GME.
· GME financing should be transparent.
· Barriers that hinder resident educational experiences in didactic settings and scholarly activity should be removed.
“For years there has been conversation that Medicare support for GME is not data-driven,” said AAIM President D. Craig Brater, MD. “Until we know true costs, decisions about cutting funding of GME in amount or methodology are educated guesses and fraught with risk of unintended consequences. However, plans to reassess GME costs should not preclude the much needed expansion of GME positions to address the physician shortage and the health care needs of the nation.”
As fiscal pressures and physician shortages cause teaching hospitals, the federal government, and other payers to re-examine the goals and financing of GME, it is critical to recognize the importance of GME to the public and ensure it is appropriately financed and organized. Consequently, in response to the current and worsening primary care physician shortage, AAIM recommends that Congress strategically increase the number of Medicare-funded positions for primary care specialties to adequately meet the nation’s health care needs. AAIM also recommends all-payer support for GME, full Medicare support for resident and fellow training, and greater funding transparency through cost reports that delineate, by institution, the amount Medicare pays in GME payments as well as the number of residents and fellows trained at each institution.
AAIM remains concerned about MedPAC’s recommendation that Medicare reduce indirect medical education (IME) payments and establish a performance-based system in October 2013. While AAIM supports accountability for public support of GME as is presently exercised by several oversight organizations, any reduction to overall GME will adversely affect the ability of teaching hospitals to train residents and fellows and moreover, to fulfill their societal role by providing health care services to the public.
IME remains a critical supplement to the Medicare direct medical education (DME) payment to ensure all reasonable direct costs are covered. AAIM strongly advocates for the reassessment of DME to reflect increased training costs. Medicare DME payments remain based on hospitals’ calculated GME costs in the 1980s, yet the costs attributable to training residents and fellows have not remained stagnant, as education practices and regulations have increased significantly and evolved over the last 20 years.