The Medicare program should continue to fund graduate medical education for at least the next decade, but should gradually begin tying payments to performance, according to a report from the Institute of Medicine.
In the report, released July 29, an IOM panel recommended that the U.S. Department of Health & Human Services create a Graduate Medical Education Policy Council, loosely modeled after the Medicare Payment Advisory Committee (MedPAC). The council would be charged with developing a strategic plan for allocating graduate medical education (GME) funds, as well as sponsoring research to determine the best mix of physician specialties and the geographic areas where they are needed most.
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The panel called for an end to the current system of providing both "direct" and "indirect" GME funds.
The panel also recommended the establishment of a GME Center within the Centers for Medicare & Medicaid Services to manage the distribution of funds.
The IOM panel called for an end to the current system of providing both "direct" and "indirect" GME funds. Instead, the panel recommends the establishment of an "operations" fund that would pay for current residency slots and a "transformation" fund that would test alternative payment methods and validate performance measures.
Initially, about 90% of the funding would go toward operations and 10% toward transformation activities, according to Gail Wilensky, Ph.D., cochair of the IOM panel and a senior fellow at Project HOPE, an international health foundation. Dr. Wilensky was commissioner of Medicare and Medicaid programs from 1990 to 1992.
The panel recommended that Medicare payments, which account for about $9.7 billion of the $15 billion spent annually by the federal government on GME, continue at current levels with an adjustment for inflation. The organizations that sponsor GME programs would receive one payment based on a national per-resident amount equal to the total value of the new GME operational fund, divided by the current number of full-time Medicare-funded training slots.
The recommendations were criticized by the Association of American Medical Colleges, which represents medical schools in the United States and Canada. Dr. Darrell G. Kirch, AAMC president and CEO, said the IOM panel’s plan for restructuring GME financing would essentially amount to a cut in funding for teaching hospitals and would create new government bureaucracies.
Dr. Gail Wilensky
"By proposing as much as a 35% reduction in payments to teaching hospitals, the IOM’s recommendations will slash funding for vital care and services available almost exclusively at teaching hospitals, including Level 1 trauma centers, pediatric intensive care units, burn centers, and access to clinical trials," Dr. Kirch said. "In addition to hurting patient care, these cuts will limit critical training settings for future physicians, nurses, and other health professionals."
The AAMC instead supports increasing the number of federally supported GME training slots.
mschneider@frontlinemedcom.com
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