Letter to CMS Regarding Volunteer Preceptorship

Herb B. Kuhn, Director
Center for Medicare Management
Centers for Medicare and Medicaid Services
7500 Security Boulevard (Room C5-15-12)
Baltimore, Maryland 21244-1850

Dear Herb:

Thank you for taking the time to meet with us last week to discuss how to resolve the issue of GME payments for medical preceptors. We all appreciate your strong interest in this matter that is so important to our members.

With respect to the idea of attestation, you asked us to put something in writing. Attached is a draft form. We can accept an attestation that 90 percent of the time which a physician spends with a resident is related to patient care activities. We think that this approach is acceptable because the hospital still bears all the costs of the residents’ stipend and benefits, as well as the fixed infrastructure costs of the residency program within the hospital.

There are still some unanswered questions with respect to attestation that we believe CMS should consider. For example, we would like to make sure that any form of attestation would not be accompanied by a process that is administratively burdensome.

The treatment of volunteer group practice physicians should be addressed along with the attestation issue. Resolution of this issue is merely an extension of the solo practitioner volunteer policy that CMS has already articulated—i.e., group practice physicians can volunteer if the group practice provides documentation that the salary paid to a physician does not involve payment for supervision. Again, how the group practice would document this needs to be discussed.

In addition, we would like to address the question of what amount of time is appropriate for the attestation. The data you have from AFMAA is just one part of the equation, since the “all or substantially all” language refers to the costs of the program, not the amount of teaching time the physician spends in the non-hospital setting.

Based on the above concerns, we can agree to an attestation stipulating that 90 percent of the time the physician spends with a resident is related to patient-specific medical care.

We are also sending you a copy of the report language in the legislation that describes the Congressional support for these off-site residency training efforts. We believe that the use of an attestation statement will resolve many of the issues involved in volunteer preceptors and GME.

We look forward to working with you to resolve the remaining issues in a similarly positive and constructive manner. In that regard, we would be pleased to host a meeting that involves the AFMAA, AOA and AAMC to finalize these issues, as well as to address the important issue of retroactivity because as I write this, hospitals are receiving nonhospital site resident disallowances for past years.

We are grateful to you, Bill Rogers and Robert Bennett for the consideration and assistance.

Sincerely,

Douglas E. Henley, MD, FAAFP
Executive Vice President