Federal Rule Puts GME Funding at Risk

Family medicine needs a big response from its physicians, and it needs that response now. That's the message in an e-mail sent via the State Legislation E-mail Discussion List urging AAFP members to respond to a proposed CMS rule that could have severe adverse effects on all family medicine residency programs. The deadline for responding to the rule is 5 p.m. Monday, June 12.

The Academy e-mail asks members to oppose a proposed rule that would reduce Medicare payments to residency programs by allowing CMS to exclude time spent in any didactic activity from calculations that determine a residency program's direct graduate medical education, or DGME, and indirect medical education, or IME, payments. The rule applies only when the didactic activities occur in a physician's office, affiliated medical school or other nonhospital setting. Didactic activities include journal clubs and seminars in which individual cases and clinical patient-care situations often are discussed.

"Given the importance of this issue, we believe it is imperative that we attempt to respond en masse to the proposed rule," says the AAFP member e-mail alert. "In this situation, unlike our alerts regarding Congress, volume is more important than individualized personal responses."

For that reason, members can cut and paste text in a model letter and send it electronically to CMS, said Kevin Burke, director of the AAFP Division of Government Relations. Directions for sending the letter electronically are included with the model letter text.

The CMS proposed rule "reverses the agency's position expressed as recently as 1999, at which time the director of acute care wrote in correspondence that patient care activities should be interpreted broadly to include 'scholarly activities, such as educational seminars, classroom lectures … and presentation of papers and research results,'" the model letter says. "I firmly believe that with the possible exception of extended time for 'bench research,' there is no residency experience that is not related to patient care activities."

The model letter urges CMS to rescind the proposed language on whether didactic time can be counted for DGME or IME payments and to "recognize the integral nature of these activities to the patient care experiences of residents during their residency programs."