Roll Call
June 10th, 2009 by Candice Chen (email author)In the June 8 Roll Call, Atul Grover of the AAMC asks –
If you or someone you love were gravely ill, where would you turn?
He suggests the best answer is America’s teaching hospitals and without an expansion of government funded graduate medical education, these hospitals will fade away. I agree that teaching hospitals provide service above educating the nation’s future physicians. Innovation, research, standby services and charity care are all products of the academic health center. However, the majority of these services are specifically funded by the government – through NIH funds and disproportionate share payments to hospitals which serve large uninsured populations.
Currently the crumbs of the piece of the pie that is GME likely do contribute to the other missions of teaching hospitals. MedPAC estimates Medicare inpatient costs increase only 2.2% for every 10% increase in resident to bed ratio (also known as indirect GME or IME). Yet Medicare pays IME at 5.5%. Opponents to adjusting the IME rate argue the extra payments fund the other missions of teaching hospitals. Whether this is the case or not, as we look to shoring up these missions, why would we continue to do it through a convoluted system whose goals are not those that we seek to satisfy. If the government plans to increase support for the missions of innovation, research, standby services and charity care then it should do it with funding specifically directed at those missions.
Today’s teaching hospitals overwhelmingly turn out specialist physicians who are contributing to the extremely costly and disjointed health care system described by Dr. Gawande in his New Yorker article. Dumping more money into the same system will only exacerbate the problem. And dumping more money into the system in the hopes that the crumbs that fall off will support the other missions of teaching hospitals is expensive and bad policy.