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MedPAC Recommends New Performance-Based System for GME Funding
System Would Be Funded Through Existing Excess IME Payments
By News Staff
The $3.5 billion is an amount that exceeds what presenter Cristina Boccuti, M.P.P., a principal policy analyst for MedPAC, called the "empirically justified" amount intended to cover Medicare's share of higher patient care costs associated with teaching.
Thus, she said, no increase in Medicare funding would be required to implement the proposed program.
Recognizing Superior Performance
"Medicare makes no distinction in its payments for low- or high-performing programs and institutions," Boccuti said during the meeting.
"The commission has discussed a need for Medicare payments to take a stronger role for encouraging delivery system reform," she added. "And that is where we are starting to pair this."
Incentive-based payments should evolve through consultations with representatives from education, insurer and provider communities and should be scaled to reflect performance levels, according to Boccuti.
Increasing Emphasis on Outcomes
However, a 2009 RAND Corp. working paper that assessed how internal medicine residencies are adapting their teaching to prepare physicians to practice within the current health care delivery system found that the residency programs have been slow to achieve these goals. One reason stipulated in the paper was varying levels of support from the residencies' institutional sponsors.
Scaling incentive-based payments to reflect performance levels of residency programs and their sponsoring institutions should help shore up that support, Boccuti said. Moreover, she added, delaying the launch of the new performance-based program for three years would allow time for HHS to develop standards for distributing the funds.
- annually publish a report that shows Medicare medical education payments received by each hospital plus each hospital's associated costs;
- conduct a workforce analysis to determine the number of residency positions needed in the United States, broken down by specialty;
- report to the Congress on how residency programs affect the financial performance of their sponsoring institutions, whether programs in all specialties should be supported equally, and whether certain residency programs are sustainable without federal support; and
- study strategies to increase the diversity of the health professional workforce -- including the proportions of underrepresented rural, lower-income and minority community members -- and report which strategies will achieve this pipeline goal.
Family Medicine Groups Urge MedPAC to Adopt New Recommendations on GME Funding
MedPAC Calls for 1 Percent Overall Payment Increase in 2011
Additional Increases for Primary Care Also Needed
2009 Interim Meeting
AMA Backs GME Funding for Nonhospital Residency Sites, Other Medical Education Initiatives
Transcript of the Medicare Payment Advisory Commission's April 1-2 meeting (403-page PDF; About PDFs)
MedPAC April 1 meeting brief: "Focusing graduate medical education financing on educational priorities" (1-page PDF; About PDFs)
MedPAC April 1 meeting presentation: "Focusing graduate medical education financing on educational priorities" (7-page PDF; About PDFs)