The Medical Education Futures Study Blog

Amidst the debates on insurance market reforms, Medicaid expansion, and maintaining benefits for Medicare beneficiaries, graduate medical education is getting attention in this round of health care reform legislation.  And we’ve created a crib sheet of the Senate Finance legislation:

Chairman’s Mark (9-16-09)

• Redistributes 80% of unused resident slots.  Hospitals must 1) maintain its number of primary care residents and 2) 75% of positions must be in primary care or general surgery.  The Secretary would take into account the likelihood that a hospital would 1) fill the positions in the first 3 years, 2) take part in innovative delivery models, and 3) have a rural training track.  The Secretary would distribute based on 1) hospitals in states with resident to population ratios in the lowest quartile, 2) hospitals in the top 25 states in terms of ration of population living in a HPSA and 3) hospitals in rural areas.  Limit per hospital is 75 FTE positions.  IME would be paid at 50% of current IME.
• “All or substantially all costs” previously defined as 90% of resident stipends and fringe benefits and costs associated with a supervising physician, in terms of the costs that must be incurred by a hospital training in a non-hospital setting is changed to mean only the costs of the resident stipends and fringe benefits during the time spent in that setting.
• Countable FTE - when calculating DGME certain non-patient activities in non-hospital settings will be included in countable FTE; when calculating IME certain non-patient care activities (e.g. didactic conferences but not research) that occurs in the hospital will be countable.
• Closing or acquire hospitals - establishes rules for the redistribution of resident cap positions in this priority order: 1) hospitals located in the same or contiguous statistical area, 2) hospitals in the same State, 3) hospitals in the same region and 4) the priorities set in the redistribution of unused slots.

Amendments to Chairman’s Mark (9-19-09)

• Bingaman #D-2 - Ensures 50% of the GME slot redistribution is prioritized for rural and underserved communities.
• Bingaman #D-8 - Establishes 1) a grant program to provide Teaching Health Centers funding to establish primary care residency programs and 2) a program to provide direct and idirect GME payments for Teaching Health Centers to run primary care residency programs, funded at $250 million for FY11 to FY15.
• Stabenow-Snowe #D-18 - Allows residency training programs receiving initial accreditation by the ACGME or a new program number by the AOA from Jan. 1, 1995 to Dec. 31, 2006 to be treated as new programs with an adjustment to the hospital’s resident limit.
• Cantwell #D-2 - Establishes a loan program for hospitals starting new residency training programs in the following specialties: family medicine, internal medicine, emergency medicine, Ob-Gyn, general surgery, preventative medicine, pediatrics and behavioral and mental health.
• Nelson-Schumer-Cantwell-Kerry #D-6 - Increases the current cap in Medicare GME funded slots by 10,000.  1/3 of new positions would be distributed to hospital training more residents than their resident limit.  2/3 will be distributed on the following criteria: 1) likelihood of filling ths positions within 3 years, 2) primary care and general surgery positions, 3) training in community health centers or community-based settings, 4) states with more medical students than residency positions and with smaller resident to medical student ratios, 5) states with low resident to population ratios and 6) limit 50 FTE residency positions.  Also the IME will be paid at the full IME adjustment.
• Nelson #D-7 - Adds an additional number of new slots equivalent to $250 million in federal spending.  Slots will be available to hospitals in the ten states with the lowest resident to population ratio.  IME will be paid at full IME adjustment.

Chairman’s Mark V2

• Accepts Bingaman #D-2, adding reserved slots meet the additional criteria of being in a state among the top 10 in terms of the ratio of the population living in a HPSA.
• Accepts Bingaman #D-8, funded at $230 million for FY11 to FY 15 for the direct and indirect GME payments.
• Accepts Nelson #D-6 with modification - “allocates an additional number of new residency training slots for redistribution by adjusting the percent of unused slots that would be included in the pool for redistribution to 65%.  Slots allocated under this amendment will be available to hospitals located in the ten states with the lowest resident-to-population ratios.” IME will be reimbursed at the full IME adjustment factor.

So Magic 8 Ball - What’s the future for GME?

Answer: Ask again later… Senate Finance mark up is ongoing.

Yesterday, the New York Times’ Health section featured an article on a summer program at the University of Washington that exposes medical students to the real life experience of being a physician.  The program educates students on the practice of medicine as well as critical facets of the health care system that will affect them as practitioners. Please click the following link to read this excellent piece, and be sure to watch the accompanying video which is embedded in the article.

Summer of Work Exposes Medical Students to System’s Ills
September 8, 2009 - Kevin Sack, The New York Times