WEB EXTRA UPDATE!
The AAFP and four other family medicine organizations have called on CMS to immediately extend a moratorium on retroactive denials of graduate medical payments to residency training programs that rely on volunteer preceptors. The request came in a Dec. 14 letter to CMS Administrator Mark McClellan, M.D., Ph.D.
The letter is family medicine's response to a Dec. 8 report by David Levinson, acting HHS inspector general. Levinson's report urged CMS and Congress to work together to extend the moratorium and clearly define the rules for use of volunteer preceptors in community-based residencies.
Family medicine's letter lauded Levinson's recommendation but added, "Because Congress will not be back in session until after the lifting of the statutory moratorium, we urge CMS to do whatever it can under its own regulatory authority to allow the use of volunteer physicians in those settings as of Jan. 1, 2005. … We call upon CMS to immediately revise its regulations to allow for the use of volunteer preceptors for family medicine on Jan. 1, 2005."
McClellan has 60 days to submit CMS' final management decision, including an action plan, to the inspector general's office. That plan could follow any of five IG recommendations, which range from continuing present regulations but defining the treatment of volunteer time to making direct Medicare payments to the supervisory physicians in nonhospital teaching settings.
Each option has advantages and disadvantages, according to Levinson. He urged Congress to resolve the question legislatively.
In the meantime, the government should extend the moratorium on CMS' policy of demanding repayment of Medicare funds to nonhospital settings that use volunteer preceptors.
"The AAFP is grateful for the inspector general's conclusions," said AAFP President Mary Frank, M.D., of Mill Valley, Calif. Medicare intermediaries' audits and retroactive repayment requests "put many family medicine residencies at financial risk," she said.
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