More than half of the U.S. Senate is urging CMS to "use its inherent regulatory authority" to reinstate a moratorium on audits that have denied graduate medical education funds to hospitals that use volunteer preceptors to teach residents in nonhospital sites. The moratorium expired Dec. 31, 2004.
Their recommendation came in a letter circulated by Sens. Susan Collins, R-Maine, and Richard Durbin, D-Ill., to be sent to CMS Administrator Mark McClellan, M.D., Ph.D.
"We are writing to express our continued concern regarding actions by the Centers for Medicare and Medicaid that could compromise the use of volunteer physicians as teachers training residents in nonhospital settings," the letter says.
Among those actions: demands for retroactive repayment of Medicare funds when residency programs use volunteer preceptors at nonhospital teaching locations.
The senators said CMS' actions conflict with congressional intent as expressed in the Balanced Budget Acts of 1997 and 1999, "which were designed to encourage rural and out-of-hospital experiences. They also put at risk the agreements that teaching hospitals, residency programs, physicians, clinics and community health centers have carefully negotiated to ensure that residents are exposed to ambulatory training," the letter continues.
In keeping with recommendations in a December 2004 HHS Office of Inspector General report (PDF file: 24 pages / 368 KB. More about PDFs.) on the issue, the senators said they wanted to work with CMS to:
- analyze financial arrangements among teaching hospitals, nonhospital facilities, and supervisory physicians in those facilities,
- study the potential impact of revisions to the current policy, and
- clarify the definition of "all or substantially all" of the costs of training residents in nonhospital settings.
