Charles P. Clayton
In its June 2009 report to Congress, the Medicare Payment Advisory Commission (MedPAC) stated it will focus future discussions about graduate medical education (GME) funding on three key issues: (1) linking GME funding to the coordination and quality of care provided by recipient institutions; (2) using GME funding as a lever to develop the right mix of physicians, including more primary care physicians; and (3) working to ensure all insurers contribute explicit funding to medical education.
The commission expanded on these areas. With respect to linking GME payment to delivery system reforms, the commission could recommend that “Medical education incentives could include, for example, higher subsidies to entities with infrastructure that facilitates high-quality efficient care, such as integrated care and communication among providers across different types of health care settings.” In terms of developing the right mix of providers, “if medical education subsidies were to more strongly favor programs that educate and train generalists, then teaching institutions (e.g., teaching hospitals) may be more inclined to invest in these programs.”
MedPAC based its future agenda on a review of curricula at the medical school and GME levels. The commission concluded its analysis with the finding that, “Residency programs’ curricula are not well aligned with objectives of delivery system reform.” Part of the curricular review included interviews with internal medicine residency program directors conducted by the RAND Corporation. Although the Alliance for Academic Internal Medicine (AAIM) supported the interview process, the alliance has raised concerns about the conclusions drawn from interviewing only 26 of 382 residency program directors in the height of recruitment season. The commission’s analysis also ignores the layers of regulation of medical education through the accreditation and certification processes as well as existing Medicare payment requirements. AAIM will make a formal response to the MedPAC report over the summer.
Congress chartered MedPAC to receive “objective,” third-party advice on Medicare payment policy. MedPAC sends recommendations to Congress but has no actual authority over Medicare payment policy. Some members of Congress and officials in the administration have recently suggested giving MedPAC authority over setting Medicare payment policy as an agency in the executive branch. Senator Jay Rockefeller (D-WV) has recently introduced legislation (S. 1110) that would enact such a transition.
MedPAC’s deliberations of medical education should continue at the next commission meeting in September 2009.