Declaring that Medicare graduate medical education, or GME, financing reform is long overdue, a consortium of five academically focused specialty organizations known as the Alliance for Academic Internal Medicine, or AAIM, has developed principles and recommendations to guide the U.S. Congress, think tanks and advisory panels in restructuring the GME system.
In a press release introducing the AAIM's Principles for Medicare GME Reform,(www.im.org) the consortium says the principles outline the shortfalls of the present financing system and propose a number of recommendations to address overall concerns, including the U.S. physician shortage, the need to expand Medicare-funded GME positions, the inadequacy of GME payments, and the need for Medicare GME support for all training time for residents and fellows.
"For years, there has been conversation that Medicare support for GME is not data-driven," said AAIM President D. Craig Brater, M.D., in the press release. "Until we know true costs, decisions about cutting funding of GME in amount or methodology are educated guesses and fraught with risk of unintended consequences."
The principles and accompanying recommendations were developed and endorsed by the Association of Professors of Medicine, the Association of Program Directors in Internal Medicine, the Association of Specialty Professors, Clerkship Directors in Internal Medicine and Administrators of Internal Medicine. The five principles laid out by the groups are that
- Medicare GME payments should be strategically used to address physician workforce and societal needs,
- Medicare GME payments should be adjusted to reflect the costs of training residents and fellows in the 21st century,
- all payers should explicitly support GME,
- GME financing should be transparent, and
- barriers that hinder resident didactic educational experiences and scholarly activity should be removed.
According to the consortium, Congress should increase the number of Medicare-funded physicians-in-training positions for primary care specialties to adequately meet the nation's health care needs, including the needs of some 32 million people who are now eligible for coverage under the new Patient Protection and Affordable Care Act.
In addition, Congress should charge CMS with calculating the current costs of direct medical education, or DME, and increase DME payments overall, because costs in recent years have increased at rates higher than inflation rates and other costs have been added. DME costs generally cover residents' and fellows' salaries and fringe benefits and teaching physicians' time.
Calling GME an "enduring public good," the consortium recommends that all health care insurers, including Medicare, Medicaid and private insurers, contribute to GME funding.
"The investment in GME is an investment in public health," the consortium says. "As a public good, the nation cannot afford not to sustain this investment."
The consortium also calls for transparency in GME financing through a system that makes payment information available to the public. Specifically, it recommends that Congress require CMS to issue an annual report that delineates the amount of Medicare GME payments each academic institution has received and the number of residents and fellows trained by each institution.
Finally, although the consortium lauds changes under the new health care reform law that provide support for outpatient training and other primary care-friendly features, it wants Medicare to count all training time, including didactic training and research, in its payment methodologies.
"Medicare GME financing reform is long overdue, and as health care reform implementation continues to unfold, the opportune time to act on GME reform is now," the consortium concludes.