CMS Administrator Mark McClellan, M.D., Ph.D., has agreed to investigate agency policies on residency training at nonhospital sites that use volunteer preceptors. The review will help determine whether those sites meet statutory requirements when they use volunteer preceptors.
McClellan indicated his interest in reviewing the issue during a May 20 meeting with the Association of American Medical Colleges, American Osteopathic Association and Academic Family Medicine Advocacy Alliance.
"It was a very positive meeting, with a lot of sharing of ideas," said Hope Wittenberg, director of government relations for AFMAA.
During the meeting, Wittenberg and her colleagues reiterated the organizations' opposition to CMS' audits of hospitals' graduate medical education funds. Many of those audits have resulted in demands for retroactive repayment of Medicare funds when residency programs use volunteer preceptors at nonhospital teaching locations. The policy poses a threat to the future viability of residency training opportunities in nonhospital sites, say academic and family medicine advocates.
Janice Nevin, M.D., M.P.H., former president of the Association of Family Medicine Residency Directors, gave a "real-world" description of the impact of CMS policy on residency training programs.
CMS contends its regulations -- which state hospitals must pay "all or substantially all" teaching costs -- require teaching hospitals to pay nonhospital preceptors for supervising residents. Academic and family medicine proponents disagree with that interpretation of the regulations, saying hospitals already meet the requirements of paying substantially all costs by paying residents' salaries and benefits and that volunteer, community-based precepting should be allowed.
McClellan indicated he was willing to look into three issues:
CMS Agrees to Review Volunteer Preceptor Issues
By Leslie Champlin
6/1/2005
- the definition of substantially all within the context of time preceptors take from patient care to supervise residents;
- the process by which supervisory costs, if any, would be determined. An April 8 "Frequently Asked Questions" (PDF file: 5 pages / 25 KB. More about PDFs.) document on the issue indicated the agency would require physician supervisory time studies and submission of physician income information;
- the potential for a "safe harbor" for group practices that have volunteer preceptors.
"They (CMS officials) didn't make promises," but the meeting gave cause for optimism, said Wittenberg.
