AAFP Seeks Flexibility in Medicare GME Funding Cap

January 24, 2019 06:15 am News Staff

Increasing the number of family medicine residency slots -- especially in the neediest communities -- continues to be a priority for the AAFP.

[physician holding drawing of hourglass]

In a Jan. 16 letter(2 page PDF) to CMS Administrator Seema Verma, M.P.H., the AAFP urged CMS to allow for more flexibility in the existing cap on Medicare support for graduate medical education (GME) -- a cap that was imposed by the Balanced Budget Act of 1997.

Adjusting the time allowed for new teaching hospitals to establish their cap for primary care residents in certain geographical areas would "help offset the growing shortage of family physicians" who serve patients in areas of need throughout the country, said the letter, signed by AAFP Board Chair Michael Munger, M.D., of Overland Park, Kan.

The Academy pointed out that currently, new teaching hospitals have five years to establish their Medicare GME funding cap on the number of residency positions, "thereby establishing a permanent ceiling for Medicare GME funding."

Specifically, "the cap is set at the number of residents at the institution five years after the first resident begins to work there."

Unfortunately, even though medical school enrollment has increased in recent years, "corresponding residency training positions at teaching hospitals have not grown as significantly," continued the letter.

And this is especially true in many rural and underserved areas of the country, where more primary care physicians are desperately needed.

The AAFP's message to CMS was crystal clear.

New teaching hospitals in economically depressed or underserved areas that express intentions to establish family medicine residency programs "should be exempted from the five-year deadline and provided with the flexibility needed to fully establish their programs."

Giving these programs some leeway "would help address urgent primary care workforce shortages and the unequal geographic distribution of current GME programs," said the letter.

It takes time to build a residency program, noted the AAFP.

"The AAFP believes five years is an insufficient window for most new programs to recruit medical educators, build infrastructure, receive accreditation and maximize enrolled residents. Additional time is critically important in areas where the development of new primary care residency programs is underfunded."

Simply put, "the current five-year window is not sufficient to scale these programs to their full potential," concluded the AAFP.

The letter also urged the agency to look for opportunities to work with the CMS Innovation Center to address primary care physician workforce shortages in communities across the country.

Additionally, the letter referenced the AAFP's GME policy and the six principles outlined in that document that could increase the uptake of primary care physicians in the very areas where they are needed the most.