A long-simmering dispute with CMS over use of volunteer preceptors in community-based residency training may come to an end as a result of the Community and Rural Medical Residency Preservation Act of 2005. If passed, the bill would affect the 61 percent of AAFP members who serve as volunteer preceptors for medical students and family medicine residents.
"This bill, if successful, will ratify the reality that, for many years, family physicians have been generously donating their time and expertise to teach students and residents," said Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education.
Given the bill's potential impact on six of every 10 Academy members, the AAFP Division of Government Relations has launched a Speak Out and a Key Contact alert to ask members to contact their legislators and urge them to support the bill. The legislation would overturn current CMS policy by clearly defining the terms under which CMS would reimburse hospitals for the cost of training residents in community programs that rely on volunteer preceptors.
The CMS policy "has the effect of reducing, by large amounts, the … payments a hospital or teaching program receives for residents training in non-hospital settings," says the Speak Out model letter to legislators. "Such reductions seriously jeopardize graduate medical education in general and family medicine residencies in particular."
Community-based training, which prepares most physicians for the practices they will ultimately have, is vital to all students and residents, the letter continues, adding, "We should be encouraging training in these settings and Medicare should be fostering, not discouraging, volunteerism."
The dispute with CMS developed in 2002, when the agency adopted a policy that required teaching hospitals to pay preceptors for the time they spend teaching. In defending the policy, CMS cited a regulation that state hospitals must pay "all or substantially all" of the cost of resident training to receive graduate medical education funding. "All or substantially all" includes preceptor salaries and, therefore, prohibits GME payment when programs use volunteer preceptors, according to the 2002 CMS position.
If passed, the Community and Rural Medical Residency Preservation Act would define "all or substantially all" as including only residents' salaries and benefits and "any other amounts, if any, that are determined by the hospital and the entity operating the non-hospital setting," said Jerome Connolly, senior government relations representative in the AAFP Division of Government Relations.
"We've been working with Sens. (Olympia) Snow and (Susan) Collins and Rep. (Kenny) Hulshof in their negotiations with CMS," said Connolly, adding "because CMS continued to ignore the issue, statutory clarification of the regulatory language was deemed necessary."
Snowe, R-Maine, and Collins, R-Maine, are co-sponsors of the Senate version of the bill, S. 2071. Other sponsors of that bill are Sens. Jeff Bingaman, D-N.M.; Byron Dorgan, D-N.D.; and John Rockefeller, D-W.V. Hulshof, R-Mo., and Rep. John Tanner, D-Tenn., co-sponsored the corresponding House measure, H.R. 4033.
