House Bill Sets Up Pilot Project for Distributing GME Funds

The AAFP and the Council of Academic Family Medicine, or CAFM, are hailing the introduction of a bipartisan graduate medical education, or GME, bill that would establish a pilot project to test and support primary care training models in nonhospital settings.

H.R. 3667, (at the THOMAS website, type "H.R. 3667" in the search box after selecting "Bill Number") which was introduced by Reps. Cathy McMorris Rodgers, R-Wash., and Mike Thompson, D-Calif., is known as the Primary Care Workforce Access Improvement Act of 2011. It establishes a pilot project that would allow a portion of GME payments to go directly to community-based primary care residency programs. Those programs then would collaborate with local hospitals to provide necessary training in inpatient care.

According to AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., Medicare GME funding currently is funneled solely through hospitals. But that model does not compensate for many of the costs of training in nonhospital settings, which is where most primary care services are provided and where primary care residents need to spend the bulk of their training time.

"More than 90 percent of care delivered by primary care physicians is in the community, and the vast majority of patients get their care in community settings," said Stream, in a prepared statement. "So this is where much of the training for primary care doctors should occur."

Although the legislation was only introduced on Dec. 15, it already has picked up key support. The CAFM, which consists of the Society of Teachers of Family Medicine, or STFM; the Association of Family Medicine Residency Directors; the Association of Departments of Family Medicine; and the North American Primary Care Research Group, is supporting the bill, as are the National Rural Health Association and a medical education partnership representing Washington, Wyoming, Alaska, Montana and Idaho.

According to Stream, "funding for physician training directly influences the types of physicians we produce as a nation. The current system doesn't foster production of primary care physicians. That's why this legislation is so important to Americans' future access to the care they need."

STFM President Jeri Hepworth, Ph.D., agreed with Stream's statement, saying, "This pilot temporarily shifts funding to entities whose sole mission is the education and training of primary care physicians. That means the educational focus will be on prevention, care coordination, implementation of the patient-centered medical home and meeting the ongoing health care needs of families, as opposed to responding to acute episodes that require costly hospitalization."

The bill would establish a five-year pilot to test four models whose principal mission is the education and training of primary care physicians. The models identified for testing are

GME payments made directly to the medical education entity would be based on that entity's number of full-time equivalent residents, according to the bill.