Family Medicine Organizations Support Senate Action to Aid Graduate Medical Education in Non-Hospital Settings

WASHINGTON – The American Academy of Family Physicians joined colleagues in the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the North American Primary Care Research Group today to express support for Sen. Olympia Snowe’s (R-Maine) action to reverse actions by Centers for Medicare and Medicaid Services (CMS) that will be destructive to family physician training programs.

The CMS recently revised its practices governing the payment of Graduate Medical Education (GME) funds to hospitals. These new practices effectively prohibit the use of volunteer teachers in non-hospital settings, and a recent regulation prohibits direct and indirect GME reimbursement for training in non-hospital settings that may have received non-Medicare funds at some point since their programs began.

Sen. Snowe introduced legislation yesterday that would provide a permanent solution for residents training in non-hospital settings. The bill, known as the Medicare Education Payment Clarification Act of 2003, S. 1897, would ensure that the Congressional intent of encouraging training of physicians in non-hospital settings -- established in the Balanced Budget Act of 1997 (BBA) -- would be clarified.

Sen. Snowe was instrumental in placing language for a long-term solution in the Senate-passed Medicare bill. She worked to include similar language in the final Medicare prescription drug bill to put a one-year moratorium on these harmful practices about the volunteer issue. This compromise was fashioned that is a stop-gap measure. A long-term solution is still needed.

Family medicine training programs will continue to be severely affected by CMS activity that does not allow payment to hospitals for residency training in non-hospital settings, where volunteer teachers are used. In a survey of family practice residency program directors, 85 percent of programs use only volunteer faculty in those settings. Additionally, some family medicine training programs that have received outside funds at any time in the past -- e.g., foundation or university funding -- will be prohibited from receiving GME reimbursement for training in non-hospital settings.

The BBA provisions are intended to encourage placement of residents in rural and other underserved areas and in non-hospital settings more like the types of medical practices they will work in upon completion of their residencies. The purpose is two-fold: to increase access to care by increasing the number of residents training in these settings, and to increase the likelihood that physicians will establish practices in rural and underserved areas.

The organizations listed above expressed support for the actions taken by Sen. Snowe and appreciation to the members of Congress who have worked with her in this effort.